Source: https://patents.google.com/patent/WO2018139668A1/en
Timestamp: 2019-11-15 06:21:37
Document Index: 290843442

Matched Legal Cases: ['art 2', 'art 10', 'art 111', 'art 111', 'art 111', 'art 20', 'art 53', 'art 20', 'art 10', 'art 122', 'art 120', 'art 122', 'art 1', 'art 20', 'art 120', 'art 20', 'art 2', 'art 20', 'art 120', 'art 120', 'art 20', 'art 20', 'art 20', 'art 11', 'art 100', 'art 111', 'art 112', 'art 120', 'art 121', 'art 122', 'art 123', 'art 21', 'art 212', 'art 32', 'art 33', 'art 50', 'art 52', 'art 53']

WO2018139668A1 - Injection device and injection method - Google Patents
Injection device and injection method Download PDF
2018-08-02 Publication of WO2018139668A1 publication Critical patent/WO2018139668A1/en
An injection device that comprises a detection unit and a puncturing unit. The detection unit comprises: an electrode that can detect the electrical characteristics of biological tissue; and a first tracking mechanism that tracks the movement of the biological tissue. The puncturing unit can puncture the biological tissue and administer a substance-to-be-administered to the biological tissue through a hollow part that is demarcated inside the puncturing unit. The position of the puncturing unit can be specified on the basis of the position of the electrode. The puncturing unit comprises a second tracking mechanism that tracks the movement of the biological tissue. The second tracking mechanism comprises a needle member and an impelling member that impels the needle member toward the distal-end side of the needle member and can expand and contract in the extension direction of the needle member in association with the movement of the needle member in the extension direction thereof.
Injection apparatus and injection method
This disclosure relates to an injection apparatus and an injection method.
Currently, in the treatment of heart failure and the like, treatments that are expected to have a therapeutic effect by injecting biological materials such as cells or biomaterials into tissues are being studied. In such procedures, instruments such as catheters are used for tissue injection. In cell therapy using such a catheter or the like, the position of the infarct is specified by performing 3D mapping or the like on a living tissue such as a heart ventricle before the injection procedure. Thereafter, injecting cells or the like as the administration target toward a desired location according to the treatment such as the boundary between the infarct and the normal myocardial tissue is performed.
However, when treatment is performed after mapping in advance, the position of the catheter on the 3D mapping can be grasped, but it is not easy to reliably grasp the tissue at the actually injected position. This problem is particularly noticeable when the living tissue moves like a beating heart. As a technique for performing treatment while following a living tissue, there is a technique disclosed in Patent Document 1, for example.
JP 2005-137898 A
However, even with the technique disclosed in Patent Document 1, there is room for improvement in reliably performing treatment at a position where treatment should be performed.
In view of the above problems, an object of the present disclosure is to provide an injection apparatus and an injection method capable of performing treatment more reliably at a position where treatment is to be performed.
An injection device as one aspect of the present invention includes a detection unit including an electrode capable of detecting electrical characteristics of a biological tissue, a first tracking mechanism that follows the movement of the biological tissue, and punctures the biological tissue. A puncture part capable of administering an administration target to a living tissue through a hollow part partitioned inside, the position of the puncture part can be specified based on the position of the electrode, and the puncture part is a living body A second follow-up mechanism that follows the movement of the tissue, wherein the second follow-up mechanism biases the needle member and the needle member toward the distal end side of the needle member, and the extending direction of the needle member And an urging member that can be expanded and contracted in the extending direction.
The injection device as one embodiment of the present invention further includes a catheter for holding the needle member, and the biasing member is an elastic member located inside the catheter.
The injection device as one embodiment of the present invention is a catheter in which the urging member holds the needle member and has a bellows-like outer surface.
In an injection apparatus as one embodiment of the present invention, the needle member includes a sensor capable of detecting biological tissue information at a distal end.
In the injection device as one embodiment of the present invention, the second follow-up mechanism follows the movement of the living tissue independently of the first follow-up mechanism.
An injection method as one aspect of the present invention includes an electrode and a detection unit including a first tracking mechanism that tracks the movement of a living tissue, and a puncturing unit, and the puncturing unit tracks the movement of the living tissue. A second follow-up mechanism that urges the needle member and the needle member toward the distal end side of the needle member, and moves the needle member in the extending direction. An injection method that is executed using an injection device that includes an urging member that can expand and contract in the extending direction, and detects electrical characteristics of the living tissue by bringing the electrode into contact with the living tissue A step of determining the presence or absence of an infarction at the puncture position of the puncture unit based on the detected electrical characteristics, and when determining that there is an infarction, puncturing the puncture unit into a living tissue, The puncture Including the administration step of administering to the administration object to body tissue through the hollow portions partitioned in the interior of.
In the injection method according to an embodiment of the present invention, when the puncture unit includes a sensor capable of detecting biological tissue information at a distal end and determines that there is an infarction, before the administration step, The method further includes a re-determination step of re-determining the presence or absence of infarction at the puncture position of the puncture unit by the sensor.
</ RTI> According to the injection device and the injection method of the present disclosure, it is possible to more reliably perform treatment at a position where treatment is to be performed.
It is a figure which shows the injection apparatus as a 1st aspect of this indication. It is sectional drawing which shows the distal end vicinity of the injection apparatus of FIG. It is the schematic which looked at the injection apparatus of FIG. 1 from the distal end side. It is a functional block diagram which shows the structure of the measuring device of FIG. It is a flowchart which shows the injection method performed using the injection apparatus of FIG. It is a figure which shows the state change of the injection apparatus of FIG. 1 accompanying execution of the injection method of FIG. It is a figure which shows the example in which a puncture part equips a distal end with a sensor. It is sectional drawing which shows the injection apparatus as a 2nd aspect of this indication. It is the schematic which looked at the injection apparatus of FIG. 8 from the distal end side. It is sectional drawing which shows the injection apparatus as a 3rd aspect of this indication. It is sectional drawing which shows the distal end vicinity of the injection apparatus as a 4th aspect of this indication. It is the figure which looked at the injection apparatus of FIG. 11 from the distal end side. It is a schematic diagram (the 1) which shows the example of arrangement | positioning of the electrode of the injection apparatus of FIG. 11 which contacts a biological tissue. FIG. 12 is a schematic diagram (part 2) illustrating an arrangement example of electrodes of the injection device in FIG. 11 that is in contact with a biological tissue. It is a figure which shows the state change of the injection apparatus of FIG. 11 accompanying execution of the injection method performed using the injection apparatus of FIG. It is sectional drawing which shows the injection apparatus as a 5th aspect of this indication. It is the figure which looked at the injection apparatus of FIG. 16 from the distal end side.
Hereinafter, each aspect of the present disclosure will be described with reference to the drawings. In each figure, the same code | symbol is attached | subjected to the common member.
FIG. 1 is a diagram illustrating an injection device 1 as a first aspect of the present disclosure. As shown in FIG. 1, the injection device 1 includes a detection unit 10, a puncture unit 20, a catheter 30, an outer cylinder member 40, and a measuring instrument 50. In FIG. 1, the outer cylinder member 40 extends from the femoral artery FA through the aorta AO to the aortic valve AV which is the entrance of the left ventricle LV of the heart lumen, and the detection unit 10, the puncture unit 20 and the catheter 30 are The state delivered through the outer cylinder member 40 to the left ventricle LV is shown. The outer cylinder member 40 is not limited to the femoral artery FA, and may extend from the radial artery of the wrist or the like to the aortic valve AV, for example.
Hereinafter, in the injection device 1, the distal end in the insertion direction of the long member inserted into the patient's body, such as the detection unit 10, the puncture unit 20, the catheter 30, and the outer cylinder member 40, is referred to as the “distal end”. Described as “proximal end”.
FIG. 2 is a cross-sectional view showing the vicinity of the distal end of the injection device 1. FIG. 3 is a schematic view of the injection device 1 as viewed from the distal end side. 2 and 3 show a state of the injection device 1 in which the spiral portion 110 described later of the detection unit 10 is discharged from the distal end of the outer cylinder member 40 (second state described later). In FIG. 3, for the convenience of explanation, illustration of the configuration other than the annular portion 111 and the puncture portion 20 described later is omitted.
As shown in FIG. 2, the detection unit 10 includes an electrode 11, a first tracking mechanism 100 that supports the electrode 11, and a linear straight portion 12 that is continuous to the base end side of the first tracking mechanism 100. ing. The electrode 11 is arrange | positioned at the front-end | tip of the detection part 10, and can detect the electrical property of the biological tissue which contacts. Examples of the electrical characteristics of the living tissue that can be detected by the electrode 11 include the surface potential of the living tissue and the impedance between the electrodes 11. The first follow-up mechanism 100 is a mechanism that follows the movement of the living tissue that the electrode 11 contacts. The linear portion 12 extends inside the outer cylinder member 40 along the extending direction of the outer cylinder member 40.
The material of the electrode 11 is preferably a material having conductivity, biocompatibility, and easy to process. Examples thereof include metals such as gold, silver, platinum, titanium, stainless steel, and copper, and conductive polymer materials such as PEDOT: PSS. In order to consider electric shock in the living body, the portion other than the contact portion with the living tissue may be covered with an insulator. Insulators such as synthetic rubber, ceramic, glass, vinyl chloride, epoxy, polyethylene naphthalate film, polyethylene terephthalate film, polyamideimide film, and other materials with electrical insulation such as synthetic nonwoven fabrics Etc.
As shown in FIGS. 2 and 3, the first follow-up mechanism 100 includes a spiral portion 110 that extends spirally around the puncture portion 20. The spiral portion 110 can be expanded and compressed along the extending direction A of the puncture portion 20, thereby following the movement of the biological tissue (for example, the heart beat) that the electrode 11 contacts to contact the spiral portion 110. The state can be maintained. As shown in FIGS. 2 and 3, the spiral portion 110 includes an annular portion 111 formed in an annular shape at the distal end in a natural state discharged from the distal end of the outer cylinder member 40. When the annular part 111 is delivered from outside the body to the affected part, the annular part 111 can be accommodated in the outer cylinder member 40 by drawing the annular part 111 into the outer cylinder member 40. The electrode 11 is provided on the distal surface 112 of the annular portion 111. In other words, as shown in FIG. 3, the electrode 11 has an annular distal end projection surface of the spiral portion 110 specified when viewed from the distal end side of the puncture portion 20 (that is, the distal end of the annular portion 111). A plurality of surfaces 112) are arranged along the circumferential direction B of the puncture unit 20. Specifically, the electrodes 11 in this embodiment are arranged in a circle along the distal surface 112, and it is sufficient that two or more electrodes 11 are arranged, preferably four or five.
The puncture unit 20 can puncture a living tissue at the distal end, and can administer an administration target to the living tissue through a hollow portion 211 described later. The position of the puncture unit 20 can be specified based on the position of the electrode 11. Specifically, the puncture position in a state where the puncture unit 20 is punctured into the living tissue (a third state described later) can be specified based on the position of the electrode 11.
The puncture unit 20 includes a second follow-up mechanism 200 that follows the movement of the living tissue. The second follower mechanism 200 follows the movement of the living tissue independently of the first follower mechanism 100. In other words, the second follow-up mechanism 200 follows the movement of the biological tissue without being interlocked with the follow-up of the first follow-up mechanism 100 to the movement of the biological tissue. The second follow-up mechanism 200 includes a needle member 210 and an elastic member 220 as an urging member. The needle member 210 defines a hollow portion 211 therein, and the hollow portion 211 is opened at the distal end 212 and the proximal end of the needle member 210. The needle member 210 includes an enlarged diameter portion 213, and the enlarged diameter portion 213 is moved in the extending direction A by the distal end side reduced diameter portion 31 and the proximal end side reduced diameter portion 32 of the catheter 30 described later. Is limited. The needle member 210 includes a sliding portion 214 that can slide in close contact with an inner peripheral surface of a lumen 33 (described later) of the catheter 30 at the proximal end.
As shown in FIG. 3, the distal end 212 of the puncture unit 20 is disposed at a position other than the central axis O of the spiral unit 110. Since the distal end 212 of the puncture unit 20 is disposed at a position other than the central axis O, the puncture unit 40 is rotated by rotating the outer cylinder member 40 around the central axis O of the spiral portion 110 along the circumferential direction B. 20 can also be rotated around the central axis O along the circumferential direction B to change the puncture position. The puncture unit 20 may be rotatable around the central axis O independently of the detection unit 10. Specifically, the puncture unit 20 may be capable of rotating around the central axis O on the proximal end side independently of the detection unit 10 and the outer cylinder member 40. Thereby, only the puncture part 20 can be rotated without rotating the electrode 11.
As shown in FIG. 3, the spiral portion 110 may include an extension portion 113 extending radially inward of the annular portion 111, and the electrode 11 may be disposed on the extension portion 113. As described above, by including the electrode 11 disposed on the extending portion 113 extending radially inward of the annular portion 111, it is possible to improve the specific accuracy of the position of the puncture portion 20 based on the position of the electrode 11. it can.
As shown in FIG. 2, the elastic member 220 is located inside the catheter 30. Specifically, the elastic member 220 is disposed between the proximal end of the diameter-expanded portion 213 of the needle member 210 and the distal end of the proximal-end-side reduced diameter portion 32 of the catheter 230, and the needle member 210 is inserted into the catheter. It is biased toward the distal end side with respect to 30. The elastic member 220 can be expanded and contracted in the extending direction A as the needle member 210 moves in the extending direction A, thereby following the movement of the biological tissue that the needle member 210 punctures at the distal end 212. The puncture state can be maintained while keeping the puncture depth constant. In FIG. 2, the elastic member 220 is shown as being disposed between the proximal end of the enlarged diameter portion 213 of the needle member 210 and the distal end of the proximal diameter side reduced diameter portion 32 of the catheter 230. It is not limited to such an arrangement. For example, in addition to the arrangement shown in FIG. 2, the elastic member 220 is also provided between the distal end of the enlarged diameter portion 213 of the needle member 210 and the proximal end of the reduced diameter portion 31 of the distal end side of the catheter 230. It may be arranged. The elastic member 220 is configured by one or more springs or the like.
As shown in FIG. 2, the catheter 30 defines a lumen 33 therein, and the lumen 33 is open at the distal end and the proximal end. The catheter 30 includes a distal-end-side reduced diameter portion 31 and a proximal-end-side reduced diameter portion 32 on the inner peripheral surface of the lumen 33. The catheter 30 houses the puncture unit 20 in the lumen 33. The lumen 33 communicates with the hollow portion 211 to form a flow path for a substance to be administered to a living tissue.
The material for forming the catheter 30 is preferably a material having a certain degree of flexibility, and examples thereof include metals and resins. Examples of the metal include pseudo-elastic alloys (including superelastic alloys) such as Ni—Ti alloys, stainless steel (for example, SUS304, SUS303, SUS316, SUS316L, SUS316J1, SUS316J1L, SUS405, SUS430, SUS434, SUS444, SUS429, SUS430F, SUS302, etc., all types of SUS), cobalt-based alloys, noble metals such as gold and platinum, tungsten-based alloys, carbon-based materials (including piano wires), and the like. Examples of the resin include polyolefin (for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof), polyvinyl chloride, polyamide, polyamide. Examples thereof include polymer materials such as elastomers, polyesters, polyester elastomers, polyurethanes, polyurethane elastomers, polyimides, fluororesins, mixtures thereof, and the above two or more polymer materials. Furthermore, engineering plastics represented by polyetheretherketone can be mentioned. A multilayer tube made of a composite formed of these metals and resins can also be used.
As shown in FIG. 2, the outer cylinder member 40 is a cylindrical member including a hollow portion 41 communicating from the distal end to the proximal end. The hollow portion 41 includes the detection unit 10, the puncture unit 20, and the catheter. 30 is stored.
FIG. 4 is a functional block diagram showing the configuration of the measuring instrument 50. As shown in FIG. 4, the measuring instrument 50 includes an input unit 51, a display unit 52, a storage unit 53, a control unit 54, and a communication unit 55.
The input unit 51 receives an input operation by the operator and outputs the received input information to the control unit 54. The input unit 51 includes an input device such as a keyboard and a mouse.
The display unit 52 displays and outputs the display screen generated by the control unit 54. The display unit 52 includes a display device such as a liquid crystal display or an organic EL display.
The storage unit 53 stores various information and programs for causing the control unit 54 to execute a specific function. The memory | storage part 53 may memorize | store the mapping data of biological tissues, such as the heart measured beforehand by 3D mapping etc., for example. The storage unit 53 is configured by a storage device such as a RAM or a ROM.
The control unit 54 controls the operation of each component constituting the measuring instrument 50. The control unit 54 executes a specific function by reading a specific program. The control unit 54 is composed of, for example, a processor.
The communication unit 55 receives the electrical characteristics of the living tissue detected by the detection unit 10 and transmits the received electrical characteristics of the living tissue to the control unit 54. Communication between the communication unit 55 and the detection unit 10 may be wired communication or wireless communication.
FIG. 5 is a flowchart showing an injection method executed using the injection apparatus 1. FIG. 6 is a diagram illustrating a state change of the injection device 1 accompanying the execution of the injection method.
As shown in FIG. 5, the injection method executed using the injection apparatus 1 includes a detection step S1 in which the electrode 11 is brought into contact with the living tissue to detect the electrical characteristics of the living tissue, and the detected electrical characteristics. Based on the determination step S2 for determining the presence or absence of infarction at the puncture position 302 of the puncture unit 20 and the determination that there is an infarction (YES in determination step S2), the infarction is punctured before the administration step S4 described later. A rotation step S3 for rotating the puncture unit 20 around the central axis O of the spiral portion 110 so as to be a puncture position 302 (see FIG. 6C) of the unit 20, and when determining that there is an infarction And administration step S4 of puncturing the living tissue 20 and administering the administration target to the living tissue through the hollow portion 211 defined inside the puncture portion 20. When it is determined in the determination step S2 that there is no infarction (NO in the determination step S2), it is possible to return to the detection step S1 and perform detection again. Hereinafter, each of the steps S1 to S4 will be described in detail.
First, as shown in FIG. 6A, the injection device 1 is a state in which the detection unit 10, the puncture unit 20 and the catheter 30 are housed in the hollow portion 41 of the outer cylinder member 40 (hereinafter referred to as “first state” as appropriate). The detection unit 10, the puncture unit 20, and the catheter 30 are delivered to the vicinity of the living tissue through the outer cylinder member 40. In this aspect, as shown in FIG. 1, the detection unit 10, the puncture unit 20, and the catheter 30 are delivered to the left ventricle LV through the outer cylinder member 40.
Next, as shown in FIG. 6B, the spiral portion 110 as the first follow-up mechanism 100 of the detection unit 10 is discharged from the hollow portion 41 of the outer cylinder member 40. When the spiral portion 110 is discharged, the electrode 11 disposed on the distal surface 112 of the annular portion 111 comes into contact with the endocardium 301 as a biological tissue. The electrode 11 in contact with the endocardium 301 detects the electrical characteristics of the endocardium 301 (detection step S1). The state of the injection device 1 at this time is also referred to as a second state. In the second state, the distal end 212 of the puncture unit 20 does not protrude further to the distal side than the distal end of the spiral portion 110.
Next, the detection unit 10 transmits the electrical characteristics of the endocardium 301 detected by the electrode 11 to the measuring device 50 via the communication unit 55. The control unit 54 determines the presence or absence of an infarction at the puncture position of the puncture unit 20 based on the received electrical characteristics (determination step S2). Specifically, based on the electrical characteristics such as the surface potential of the living tissue and the impedance between the electrodes 11, it can be determined whether or not the living tissue has an infarct. At this time, when the storage unit 53 stores mapping data of biological tissue measured in advance, the presence or absence of infarction can be determined with higher accuracy by using this mapping data. Instead of the control unit 54, for example, the user of the injection device 1 may determine the presence or absence of infarction at the puncture position of the puncture unit 20 based on the detected electrical characteristics of the endocardium 301.
In the determination step S2, it is determined whether or not there is an infarction on the locus of the puncture position 302 (see FIG. 6C) of the puncture unit 20 when the puncture unit 20 is rotated around the central axis O of the spiral unit 110. Also good. When it is determined that there is an infarction (YES in determination step S2), before the administration step S4, the puncture unit 20 is placed on the central axis O of the spiral unit 110 so that the infarction is at the puncture position 302 of the puncture unit 20. You may rotate around (rotation step S3). When it is determined that there is no infarction (NO in determination step S2), the process returns to the detection step S1, and the position of the endocardium 301 with which the electrode 11 contacts may be changed.
And when it determines with having an infarction as shown in FIG.6 (c) (YES of determination step S2), the puncture part 20 is punctured to the endocardium 301 as a biological tissue. The state of the injection device 1 at this time is also referred to as a third state. Thereafter, the administration subject is administered to the endocardium 301 through the hollow portion 211 (administration step S4). Thus, according to the injection method performed using the injection apparatus 1 of this aspect, it is possible to more reliably perform treatment at a position where treatment is to be performed.
FIG. 7 is a diagram illustrating an example in which the puncture unit 20 includes the sensor 21 at the distal end 212. As shown in FIG. 7, the needle member 210 as the puncture unit 20 may include a sensor 21 that can detect biological tissue information at the distal end 212. The sensor 21 may be, for example, a contact sensor that detects contact with the endocardium 301 or a motion sensor that detects wall motion. FIG. 7 shows a configuration in which the sensor 21 is exposed to the outside from the distal end 212 through the sensor hollow portion 215 partitioned in the puncture portion 20, but is not limited to such a mode. For example, the needle member 210 itself may function as the sensor 21.
When the puncture unit 20 includes the sensor 21, the injection method performed using the injection device 1 determines that the puncture unit 20 has been inspected by the sensor 21 before the administration step S4 when it is determined in the determination step S2 that there is an infarction. A redetermination step may be further included in which the presence / absence of infarction at the puncture position 302 is determined again. Thereby, the presence or absence of infarction at the puncture position 302 can be more reliably determined. Therefore, it is possible to more reliably perform treatment at a position where treatment is to be performed.
FIG. 8 is a cross-sectional view showing an injection device 2 as a second aspect of the present disclosure. FIG. 9 is a schematic view of the injection device 2 as viewed from the distal end side.
8 and 9, the injection device 2 includes a detection unit 10, a puncture unit 20, a catheter 30, an outer cylinder member 40, and a measuring instrument (not shown). In the injection device 2, the distal end 212 of the puncture unit 20 is disposed at the position of the central axis O of the spiral portion 110. Since the injection device 2 has the same configuration as the injection device 1 except that the distal end 212 of the puncture unit 20 is disposed at the position of the central axis O of the spiral portion 110, the description thereof is omitted. In the injection device 2, unlike the injection device 1, the puncture position cannot be changed by rotating the puncture portion 20 around the central axis O along the circumferential direction B, but the puncture position by the electrode 11 is easier. Can be specified.
Since the injection method executed using the injection device 2 is the same as the injection method executed using the injection device 1 except that the rotation step S3 is not included, the description thereof will be omitted. Thus, also by the injection method performed using the injection apparatus 2 of this aspect, a treatment can be more reliably performed at a position where treatment is to be performed.
In the injection device 2, like the injection device 1, the puncture unit 20 may include a sensor 21 at the distal end 212. When the puncture unit 20 includes the sensor 21, the injection method executed using the injection device 2 may further include a re-determination step, similar to the injection method executed using the injection device 1.
FIG. 10 is a cross-sectional view showing an injection device 3 as a third aspect of the present disclosure. FIG. 10A is a state in which a catheter 230 described later is expanded, and FIG. 10B is a state in which the catheter 230 is contracted. Respectively. FIG. 10B shows only the puncture unit 20 for convenience of explanation. As shown in FIG. 10, the injection device 3 includes a detection unit 10, a puncture unit 20, an outer cylinder member 40, and a measuring instrument (not shown). As shown in FIG. 10, in the injection device 3, the second follow-up mechanism 200 includes a needle member 210 and a catheter 230 as an urging member. Unlike the injection device 1, the injection device 3 does not include the catheter 30. Since the configuration of the injection device 3 is the same as that of the injection device 1 except for the configuration described above, the description thereof is omitted.
The catheter 230 internally defines a lumen 231 that opens at the distal end and the proximal end. The catheter 230 holds the needle member 210 in the lumen 231 with the distal end 212 of the needle member 210 exposed to the outside. The lumen 231 communicates with the hollow portion 211 of the needle member 210 to form a flow path for a substance to be administered to a living tissue. The catheter 230 has a bellows-like outer surface, and is configured to be stretchable along the extending direction of the catheter 230.
Since the injection method executed using the injection device 3 is the same as the injection method executed using the injection device 1 except that the rotation step S3 is not included, the description thereof will be omitted. Thus, also by the injection method performed using the injection apparatus 3 of this aspect, a treatment can be more reliably performed at a position where treatment is to be performed.
In the injection device 3, the puncture unit 20 may include a sensor 21 at the distal end 212, as in the injection device 1. When the puncture unit 20 includes the sensor 21, the injection method executed using the injection device 3 may further include a redetermination step, similar to the injection method executed using the injection device 1.
FIG. 11 is a cross-sectional view showing the vicinity of the distal end of the injection device 4 according to the fourth aspect of the present disclosure. FIG. 12 is a view of the injection device 4 as seen from the distal end side.
As shown in FIG. 11, the injection device 4 includes a detection unit 10, a puncture unit 20, a catheter 30, an outer cylinder member 40, and a measuring instrument (not shown). Since the configuration of the injection device 4 other than the detection unit 10 is the same as that of the injection device 2 according to the second aspect of the present disclosure, description thereof will be omitted.
As shown in FIG. 11, the detection unit 10 includes an electrode 11, a first tracking mechanism 100, and a linear portion 12 that is continuous to the base end side of the first tracking mechanism 100. The electrode 11 is arrange | positioned at the front-end | tip of the detection part 10, and can detect the electrical property of the biological tissue which contacts. The first follow-up mechanism 100 is a mechanism that follows the movement of the living tissue that the electrode 11 contacts. The straight portion 12 extends inside the outer cylinder member 40 along the extending direction of the outer cylinder member 40.
As shown in FIGS. 11 and 12, the first follow-up mechanism 100 is arranged at a position on the radially outer side of the puncture portion 20 and extends along the extending direction A of the puncture portion 20. It has. The linear portion 120 is made of a flexible member and can be deformed. In the example shown in FIGS. 11 and 12, the linear portion 120 is curved toward the radially outer side of the puncture portion 20 on the distal end 121 side. The electrode 11 is provided so as to cover the circumferential direction at a predetermined position in the extending direction of the linear portion 120. The linear portion 120 includes a fixing portion 122 for fixing the linear portion 120 to the living tissue at the distal end 121. The fixing part 122 is constituted by, for example, a claw-like member, and is a member for fixing the distal end 121 of the linear part 120 at the contact position when it comes into contact with a living tissue. The fixing part 122 may be configured by the electrode 11. Although FIG. 11 shows an example in which a plurality of electrodes 11 are arranged in each linear portion 120, one or more electrodes 11 need only be arranged in each linear portion 120.
FIG. 13 is a schematic diagram (part 1) showing an arrangement example of the electrodes 11 of the injection device 4 that comes into contact with a living tissue. In FIG. 13, black circles indicate positions where the electrodes 11 are arranged. As shown in FIG. 12, since the plurality of linear portions 120 are provided along the circumferential direction B of the puncture portion 20, the distal end 121 of the linear portion 120 is in contact with the living tissue. As shown in FIG. 13A, the plurality of electrodes 11 are arranged along the circumferential direction B of the puncture unit 20.
By the way, while the distal end 121 of the linear portion 120 is in contact with the living tissue, the distal end 121 of the linear portion 120 is fixed to the living tissue while the distal end 121 is fixed to the living tissue by the fixing portion 122. You may rotate along the circumferential direction B around. Thereby, as shown in FIG.13 (b), the some electrode 11 is arrange | positioned along the circumferential direction B of the puncture part 20 more extensively. Therefore, the electrode 11 can acquire the electrical characteristics of the living tissue in a wider range. As shown in FIG. 12, the linear part 120 may have a bending rod 123 formed along the circumferential direction B of the puncture part 20. Thereby, it becomes easier to arrange the electrode 11 as shown in FIG.
FIG. 14 is a schematic diagram (part 2) illustrating an arrangement example of the electrodes 11 of the injection device 4 that comes into contact with a living tissue. In FIG. 14, black circles indicate positions where the electrodes 11 are arranged. When the distal end 121 side of the linear portion 120 is not curved outward in the radial direction of the puncture portion 20, the distal end 121 of the linear portion 120 is fixed to the living tissue, and the vicinity of the linear portion 120 is fixed. By rotating the distal end side around the puncture unit 20 along the circumferential direction B, the electrode 11 can be arranged on the same circumference along the circumferential direction B of the puncture unit 20 as shown in FIG. .
FIG. 15 is a diagram showing a state change of the injection device 4 accompanying the execution of the injection method executed using the injection device 4. The injection method executed using the injection device 4 is the same as the injection method executed using the injection device 1 except that the rotation step S3 is not included. That is, the injection method executed using the injection device 4 includes a detection step S1, a determination step S2, and an administration step S4. Hereinafter, among the injection methods executed using the injection device 4, differences from the injection method executed using the injection device 1 will be mainly described.
First, as shown in FIG. 15A, the injection device 4 is in a first state in which the detection unit 10, the puncture unit 20, and the catheter 30 are housed in the hollow portion 41 of the outer cylinder member 40. The part 20 and the catheter 30 are delivered through the outer cylinder member 40 to the vicinity of the living tissue. In this aspect, as in the first aspect, as shown in FIG. 1, the detection unit 10, the puncture unit 20, and the catheter 30 are delivered to the left ventricle LV through the outer cylinder member 40.
Next, as shown in FIG. 15 (b), the linear portion 120 as the first follow-up mechanism 100 of the detection unit 10 is discharged from the hollow portion 41 of the outer cylinder member 40. If the linear part 120 is discharged | emitted, the electrode 11 arrange | positioned at the linear part 120 will contact the endocardium 301 as a biological tissue. The electrode 11 in contact with the endocardium 301 detects the electrical characteristics of the endocardium 301 (detection step S1). The state of the injection device 4 at this time is also referred to as a second state. In the second state, the distal end 212 of the puncture portion 20 does not protrude further to the distal side than the distal end 121 of the linear portion 120.
In the injection method executed using the injection device 4, the proximal end side of the linear portion 120 is punctured before the detection step S1 with the distal end 121 of the linear portion 120 in contact with the living tissue. An arrangement step of rotating around the part 20 along the circumferential direction B and arranging the plurality of electrodes 11 along the circumferential direction B of the puncture part 20 may be further included.
Next, the detection unit 10 transmits the electrical characteristics of the endocardium 301 detected by the electrode 11 to the measuring device 50 via the communication unit 55. The control unit 54 determines the presence or absence of an infarction at the puncture position of the puncture unit 20 based on the received electrical characteristics (determination step S2). The determination step S2 is executed in the same manner as the injection method executed using the injection device 1.
And as shown in FIG.15 (c), when it determines with having an infarction (YES of determination step S2), the puncture part 20 is punctured to the endocardium 301 as a biological tissue. The state of the injection device 4 at this time is also referred to as a third state. Thereafter, the administration subject is administered to the endocardium 301 through the hollow portion 211 (administration step S4). Thus, also by the injection method performed using the injection apparatus 4 of this aspect, a treatment can be more reliably performed at a position where treatment is to be performed. When it is determined that there is no infarction (NO in determination step S2), the process returns to the detection step S1, and the position of the endocardium 301 with which the electrode 11 contacts may be changed.
In the injection device 4, the puncture unit 20 may include a sensor 21 at the distal end 212, as in the injection device 1. When the puncture unit 20 includes the sensor 21, the injection method executed using the injection device 4 may further include a redetermination step, similar to the injection method executed using the injection device 1.
The injection device 4 may be configured to include the needle member 210 and the catheter 230 as an urging member as the second follow-up mechanism 200, similarly to the injection device 3. In this case, the injection device 4 may not include the catheter 30.
FIG. 16 is a cross-sectional view showing an injection device 5 as a fifth aspect of the present disclosure. FIG. 17 is a view of the injection device 5 as seen from the distal end side.
As shown in FIG. 16, the injection device 5 includes a detection unit 10, a puncture unit 20, an outer cylinder member 40, and a measuring instrument (not shown). As shown in FIG. 16, in the injection device 5, the outer cylinder member 40 functions as the first follower mechanism 100. Specifically, the outer cylinder member 40 has a bellows-like outer surface, and is configured to be extendable along the extending direction of the outer cylinder member 40. The detection unit 10 includes a distal end edge 13 formed at the edge of the distal end of the outer cylinder member 40. As shown in FIG. 17, the electrode 11 is disposed on the distal surface of the distal end edge 13 along the circumferential direction of the outer cylinder member 40. Since the configuration of the injection device 5 is the same as that of the injection device 2 except for the configuration described above, the description thereof is omitted.
Since the injection method executed using the injection device 5 is the same as the injection method executed using the injection device 1 except that the rotation step S3 is not included, the description thereof will be omitted. Thus, also by the injection method performed using the injection apparatus 5 of this aspect, a treatment can be more reliably performed at a position where treatment is to be performed.
In the injection device 5, as in the injection device 1, the puncture unit 20 may include a sensor 21 at the distal end 212. When the puncture unit 20 includes the sensor 21, the injection method executed using the injection device 5 may further include a re-determination step, similar to the injection method executed using the injection device 1.
The present disclosure is not limited to the configuration specified in each of the above-described embodiments, and various modifications can be made without departing from the contents described in the claims.
1, 2, 3, 4, 5: Injection device 10: Detection part 11: Electrode 12: Linear part 100: First follower mechanism 110: Spiral part 111: Annular part 112: Distal surface 113 of the annular part: Extension part 120: linear part 121: distal end 122 of the linear part 122: fixing part 123: bending rod 13: distal edge 20: puncture part 21: sensor 200: second follower mechanism 210: needle member 211: hollow part 212: Distal end 213 of needle member (puncture portion): Diameter expansion portion 214: Sliding portion 215: Sensor hollow portion 220: Elastic member (biasing member)
230: Catheter (biasing member)
231: Lumen 30: Catheter 31: Distal end side reduced diameter part 32: Proximal end side reduced diameter part 33: Lumen 40: Outer cylinder member 41: Hollow part 50: Measuring instrument 51: Input part 52: Display part 53: Storage unit 54: control unit 55: communication unit 301: endocardium (biological tissue)
302: Puncture position A: Extension direction of puncture part (needle member) B: Circumferential direction O of the puncture part O: Center axis line AO: Aorta AV: Aortic valve FA: Femoral artery LV: Left ventricle
A detection unit comprising: an electrode capable of detecting electrical characteristics of the biological tissue; and a first tracking mechanism that follows the movement of the biological tissue;
A puncture part capable of puncturing a biological tissue and administering a substance to be administered to the biological tissue through a hollow section partitioned inside;
The position of the puncture portion can be specified based on the position of the electrode,
The puncture unit includes a second follow-up mechanism that follows the movement of the living tissue,
The second follow-up mechanism biases the needle member and the needle member toward the distal end side of the needle member, and can be expanded and contracted in the extending direction as the needle member moves in the extending direction. And an urging member.
A catheter for holding the needle member;
The injection device according to claim 1, wherein the urging member is an elastic member located inside the catheter.
The injection device according to claim 1, wherein the urging member is a catheter that holds the needle member and has a bellows-like outer surface.
The injection device according to any one of claims 1 to 3, wherein the needle member includes a sensor capable of detecting biological tissue information at a distal end.
The injection device according to any one of claims 1 to 4, wherein the second follow-up mechanism follows the movement of a living tissue independently of the first follow-up mechanism.
A detection unit including a first tracking mechanism that follows the movement of the electrode and the living tissue; and a puncturing unit, the puncturing unit including a second tracking mechanism that tracks the movement of the living tissue; The follow-up mechanism urges the needle member and the needle member toward the distal end side of the needle member, and can be expanded and contracted in the extending direction as the needle member moves in the extending direction. An injection method executed using an injection device comprising:
A detection step of detecting electrical characteristics of the living tissue by contacting the electrode with the living tissue;
A determination step of determining the presence or absence of infarction at the puncture position of the puncture portion based on the detected electrical characteristics;
When it is determined that there is an infarction, the administration step of puncturing the puncture portion into the biological tissue and administering the administration substance to the biological tissue through the hollow portion partitioned inside the puncture portion;
The puncture unit includes a sensor capable of detecting biological tissue information at a distal end,
The injection method according to claim 6, further comprising a re-determination step of re-determining whether or not there is an infarction at the puncture position of the puncture unit by the sensor before the administration step when it is determined that there is an infarction.
PCT/JP2018/002920 2017-01-30 2018-01-30 Injection device and injection method WO2018139668A1 (en)
WO2018139668A1 true WO2018139668A1 (en) 2018-08-02
ID=62979664
PCT/JP2018/002920 WO2018139668A1 (en) 2017-01-30 2018-01-30 Injection device and injection method
WO (1) WO2018139668A1 (en)
JPH07507470A (en) * 1992-06-05 1995-08-24
JP2004008264A (en) * 2002-06-03 2004-01-15 Terumo Corp Catheter for injection of liquid medicine
JP2007020628A (en) * 2005-07-12 2007-02-01 Terumo Corp Catheter and medical device
2018-01-30 WO PCT/JP2018/002920 patent/WO2018139668A1/en active Application Filing