JPWO2020050988A5 - - Google Patents
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- JPWO2020050988A5 JPWO2020050988A5 JP2021503118A JP2021503118A JPWO2020050988A5 JP WO2020050988 A5 JPWO2020050988 A5 JP WO2020050988A5 JP 2021503118 A JP2021503118 A JP 2021503118A JP 2021503118 A JP2021503118 A JP 2021503118A JP WO2020050988 A5 JPWO2020050988 A5 JP WO2020050988A5
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- 230000037431 insertion Effects 0.000 claims description 5
- 238000003780 insertion Methods 0.000 claims description 5
- 210000003462 vein Anatomy 0.000 claims description 5
- 239000012530 fluid Substances 0.000 claims 2
- 230000017531 blood circulation Effects 0.000 claims 1
- 238000001990 intravenous administration Methods 0.000 claims 1
- 210000003240 portal vein Anatomy 0.000 description 11
- 230000037361 pathway Effects 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
Description
一実施形態では、針の遠位端は、門脈の壁を穿刺するための尖端を含み、圧力感知装置の本体の遠位端は、丸みを帯びた先端を含み、挿入形態では、本体の遠位端は、針の尖端が内視鏡の作業チャンネルを損傷することを防止するために針の尖端に対して配置される。 In one embodiment, the distal end of the needle includes a tip for puncturing the wall of the portal vein, the distal end of the body of the pressure sensing device includes a rounded tip, and in the inserted form, the body of the body. The distal end is placed relative to the needle tip to prevent the needle tip from damaging the working channel of the endoscope.
一実施形態では、圧力感知装置は、尖端が露出されて静脈の壁を穿刺するように針に対して近位方向に移動される。
一実施形態では、圧力感知装置の本体の遠位端は、尖端を含み、針の遠位端は丸みを帯びており、挿入形態において、圧力感知装置の尖端は、針のチャンネル内に収容され、圧力感知形態において、圧力感知装置は、針に対して遠位方向に移動され、門脈の壁を穿刺するために本体の尖端を露出させる。
In one embodiment, the pressure sensing device is moved proximally to the needle so that the apex is exposed and punctures the wall of the vein.
In one embodiment, the distal end of the body of the pressure sensing device includes a tip, the distal end of the needle is rounded, and in the inserted form, the tip of the pressure sensing device is housed within the channel of the needle. In the pressure sensing mode, the pressure sensing device is moved distally to the needle, exposing the tip of the body to pierce the wall of the portal vein.
一実施形態では、スタイレットの遠位端は尖端を含み、針の遠位端は丸みを帯びており、挿入形態では、スタイレットの尖端は、針のチャンネル内に収容され、穿刺形態では、スタイレットの尖端は、針の遠位端を越えて遠位方向に移動される。 In one embodiment, the distal end of the stylet includes the apex, the distal end of the needle is rounded, in the inserted form the apex of the stylet is housed within the channel of the needle, and in the puncture form, The tip of the stylet is moved distally beyond the distal end of the needle.
一実施形態では、針の遠位端は尖端を含み、スタイレットの遠位端は丸みを帯びており、挿入形態では、スタイレットの遠位端は、針の尖端が内視鏡の作業チャンネルを損傷するのを防止し、穿刺形態では、スタイレットは、針に対して近位方向に引かれて静脈の壁を穿刺するために針の尖端を露出させるために針の遠位端に対して配置される。 In one embodiment, the distal end of the needle includes the apex, the distal end of the stylet is rounded, and in the inserted form, the distal end of the stylet has the apex of the needle as the working channel of the endoscope. In the puncture form, the stylet is pulled proximal to the needle to puncture the wall of the vein and to expose the tip of the needle to the distal end of the needle. Will be placed.
スタイレット１０４は、近位端（図示せず）から遠位端１１８まで長手方向に延び且つ針１０２のチャンネル１０８内で摺動可能な寸法及び形状に形成される。遠位端１１８は丸みを帯びており、挿入形態において、スタイレット１０４は、針１０２のチャンネル内に受承され、丸みを帯びた遠位端１１８は、針１０２の遠位端１１６に整合、又は遠位端をわずかに超えて遠位方向に延びて、針１０２の尖端１１０が門脈１０に隣接する標的部位に移動された時、非標的組織に対する損傷を最小限にする（すなわち、針１０２が標的組織に挿入される経路を囲む組織を不注意に穿刺又は損傷すること、及び、針１０２を標的組織に挿入する間にチャンネル１０８内に組織が集まることを防止する）。 The stylet 104 extends longitudinally from the proximal end (not shown) to the distal end 118 and is formed in a size and shape slidable within channel 108 of the needle 102. The distal end 118 is rounded, and in the inserted form, the stylet 104 is received within the channel of the needle 102 and the rounded distal end 118 is aligned with the distal end 116 of the needle 102. Or, when extending distally just beyond the distal end and the tip 110 of the needle 102 is moved to the target site adjacent to the portal vein 10, damage to non-target tissue is minimized (ie, needle). Prevents inadvertent puncture or damage to the tissue surrounding the pathway into which the 102 is inserted into the target tissue, and collection of tissue within channel 108 while the needle 102 is inserted into the target tissue).
図４に示すように、本開示の別の例示的な実施形態にかかるシステム２００は、上記のシステム１００とｊほぼ同一であり、針２０２及び圧力感知装置２０６を含む。しかしながら、システム２００は、門脈２０の内部にアクセスするために、図４の工程１～４に示すように、スタイレットを必要としない。むしろ、圧力感知装置２０６が、丸みを帯びた遠位端２２２を含み、内視鏡の作業チャンネルの中を通って門脈２０に近接する標的部位に針２０２を挿入する間針２０２のチャンネル２０８内に受承されている。システム１００のスタイレット１０４と同様に、この実施形態の圧力感知装置２０６は、針２０２のチャンネル２０８内に配置され、圧力感知装置２０６の丸みを帯びた遠位端２２２は、組織がチャンネル２０８に入ること、及び／又は針２０２の尖端２１０が針２０２の挿入中に内視鏡の作業チャンネルを損傷することを防止するとともに、針２０２が内視鏡から遠位方向に延ばされた時、非標的組織に対する損傷を防止する。 As shown in FIG. 4, the system 200 according to another exemplary embodiment of the present disclosure is substantially identical to the system 100 described above and includes a needle 202 and a pressure sensing device 206. However, the system 200 does not require a stylet to access the interior of the portal vein 20, as shown in steps 1-4 of FIG. Rather, the channel of the needle 202 in which the pressure sensing device 206 includes the rounded distal end 222 and inserts the needle 202 into the target site close to the portal vein 20 through the working channel of the endoscope. It is accepted within 208. Similar to the stylet 104 of the system 100, the pressure sensing device 206 of this embodiment is located within the channel 208 of the needle 202, and the rounded distal end 222 of the pressure sensing device 206 is tissue channel 208. When entering and / or preventing the tip 210 of the needle 202 from damaging the working channel of the endoscope during insertion of the needle 202 and extending the needle 202 distally from the endoscope. , Prevent damage to non-target tissue.
針２０２及び圧力感知装置２０６は、システム１００の針１０２及び圧力感知装置１０６とほぼ同一である。上記のように、圧力感知装置２０６は、丸みを帯びた遠位端２２２を含み、針２０２の遠位尖端２１０が、挿入中に内視鏡の作業チャンネルを損傷するのを防止する。したがって、挿入形態では、圧力感知装置２０６は、丸みを帯びた遠位端２２２の位置が針２０２の遠位尖端２１０に一致、又はそれを超えてわずかに遠位に突出するように、針２０２内に配置される。したがって、この実施形態では、圧力センサ２１２は、圧力感知装置２０６の長手方向本体２２０の遠位部分２１４に沿って配置されなければならない為、圧力感知装置２０６が針２０２に対して挿入形態にある時、圧力センサ２１２は、針２０２の一部に覆われる。言い換えれば、針２０２の遠位尖端２１０が、針２０２の遠位端２１６でテーパー状に形成される場合、圧力センサ２１２は、本体２２０の遠位端２２２から十分に離れているため、圧力センサ２１２は、針２０２内の圧力感知装置２０６の回転方向に拘わらず針２０２の一部によって完全に覆われる。 The needle 202 and the pressure sensing device 206 are substantially the same as the needle 102 and the pressure sensing device 106 of the system 100. As mentioned above, the pressure sensing device 206 includes a rounded distal end 222 to prevent the distal tip 210 of the needle 202 from damaging the working channel of the endoscope during insertion. Thus, in the inserted form, the pressure sensing device 206 is such that the position of the rounded distal end 222 coincides with, or extends slightly beyond, the distal apex 210 of the needle 202. Placed inside. Therefore, in this embodiment, the pressure sensor 212 must be disposed along the distal portion 214 of the longitudinal body 220 of the pressure sensing device 206, so that the pressure sensing device 206 is in the inserted form with respect to the needle 202. At this time, the pressure sensor 212 is covered with a part of the needle 202. In other words, if the distal tip 210 of the needle 202 is tapered at the distal end 216 of the needle 202, the pressure sensor 212 is sufficiently far away from the distal end 222 of the body 220 and is therefore a pressure sensor. The 212 is completely covered by a portion of the needle 202 regardless of the direction of rotation of the pressure sensor 206 in the needle 202.
圧力感知装置４０６は、上記の圧力感知装置２０６とほぼ同一であり、長手方向に延びる本体４２０と、その遠位部分４１４に沿って配置された圧力センサ４１２とを含む。しかしながら、丸みを帯びた遠位端ではなく、本体４２０の遠位端４２２は、尖端４２８を含み、尖端４２８は、遠位端４２２の先細りによって形成されている。尖端４２８は、いくつかの構成のいずれかを有する。一例では、尖端４２８は、本体４２０の長手方向軸に対して直角でない角度で延びる先細の遠位に面する表面によって形成される。別例では、図７に示すように、圧力感知装置４０６'の本体４２０'の遠位端４２２'は、尖端４２８'を形成するために円錐状をなして先細にされる。さらに別例では、図８に示すように、本体４２０”の遠位端４２２”は、丸みを帯びた縁４３０”を含み、尖端４２８”は、そこから遠位方向に延びている。尖端４２８”は円錐形である。図７，８に示す両方の例において、尖端４２８'、４２８”はそれぞれ、本体４２０'、４２０”の長手方向軸線に対してほぼ中心に置かれる。尖端４２８'、４２８”が中心にあるため、尖端４２８'、４２８”が内視鏡の作業チャンネルを損傷する可能性が低減され、必要に応じて、尖端４２８'、４２８”を含む圧力感知装置は、門脈へのアクセスを得るために、針４０２を使用せずに、内視鏡の作業チャンネルの中に直接挿入される。 The pressure sensing device 406 is substantially the same as the pressure sensing device 206 described above, and includes a main body 420 extending in the longitudinal direction and a pressure sensor 412 arranged along a distal portion 414 thereof. However, rather than the rounded distal end , the distal end 422 of the body 420 comprises the tip 428, which is formed by the tapering of the distal end 422. The tip 428 has one of several configurations. In one example, the tip 428 is formed by a tapered distal facing surface that extends at an angle not perpendicular to the longitudinal axis of the body 420. In another example, as shown in FIG. 7, the distal end 422'of the body 420' of the pressure sensing device 406'is tapered in a conical shape to form a tip 428'. In yet another example, as shown in FIG. 8, the distal end 422 "of the body 420" includes a rounded edge 430 "and the apex 428" extends distally from it. The tip 428 "is conical. In both examples shown in FIGS. 7 and 8, the tip 428', 428" is approximately centered on the longitudinal axis of the body 420', 420, respectively. Since the'428 "is central, the possibility that the tip 428', 428" will damage the working channel of the endoscope is reduced, and if necessary, the pressure sensing device containing the tip 428', 428 " To gain access to the portal vein, it is inserted directly into the working channel of the endoscope without the use of a needle 402.
代替的な実施形態によれば、図１９～２０に示すように、圧力感知装置７０６'は、圧力感知装置７０６とほぼ同一であり、装置７０６'は、本体７２０'の中を長手方向に貫通して延びる作業チャンネル７５２'と、接続ケーブル７２４'によって装置７０６’の近位端に接続された圧力センサ７１２'とを含む長手方向本体７２０'を備える。しかしながら、圧力センサ７１２'は、図２に関して示し且つ説明した圧力センサ１１２と同様に本体７２０'の遠位部分７１４'を通って横方向に延びる凹部７２６'内に取り付けられる。この実施形態では、圧力センサ７１２'は、本体７２０'の遠位端７２２'から離れているため、遠位端７２２'は、（示すように）丸みを帯びていてもよいし、又は門脈を穿刺するために尖端を含んでもよい。圧力感知装置７０６と同様に、圧力感知装置７０６'は、システム１００～５００に関して説明したように、門脈１０６～５０６とほぼ同一の方法で使用することができる。 According to an alternative embodiment, as shown in FIGS. 19-20, the pressure sensing device 706'is substantially identical to the pressure sensing device 706, and the device 706' penetrates longitudinally through the body 720'. It comprises a longitudinal body 720'including a working channel 752'extended and a pressure sensor 712' connected to the proximal end of the device 706' by a connecting cable 724'. However, the pressure sensor 712'is mounted in a recess 726' that extends laterally through the distal portion 714' of the body 720', similar to the pressure sensor 112 shown and described with respect to FIG. In this embodiment, the pressure sensor 712'is separated from the distal end 722' of the body 720', so that the distal end 722'may be rounded (as shown) or portal vein. May include a tip to puncture. Similar to the pressure sensing device 706, the pressure sensing device 706'can be used in much the same way as the portal veins 106-506, as described for systems 100-500.
図２１に示すように、システム８００は、上記システム（例えば、システム２００、４００）に実質的に類似し、針８０２及び圧力感知装置７０６に実質的に類似する圧力感知装置８０６を含む。図２１は、圧力感知装置８０６が挿入されている門脈内の圧力を測定し及び／又は門脈に治療を実施するための工程１，工程２を示す。針８０２は、針２０２、４０２とほぼ同一であり、圧力感知装置８０６が摺動可能に受承される長手方向チャンネル８０８を含む。圧力感知装置８０６は、圧力感知装置７０６とほぼ同一であり、例えば、診断及び／又は治療器具などの別の器具８６０の通過のために、圧力感知装置８０６の長手方向に延びる本体８２０の中を貫通して延びる作業チャンネル８５２を含む。しかしながら、圧力センサ８１２は、本体８２０内又は本体８２０に沿って固定されていない。むしろ、圧力センサ８１２は、圧力センサ８１２が本体８２０の遠位端８２２内に受承される第１の構成（工程１）と、圧力センサ８１２が遠位端８２２から出て遠位方向に移動されて、接続ケーブル８２４によって圧力感知装置の近位端に接続された圧力センサ８１２が、遠位端８２２の外に遠位方向に延びる時遠位端８２２から横方向に離れるように移動される第２の構成（工程２）との間で本体８２０内に移動可能に収容される。本体８２０の遠位端８２２は、尖端を含むものとして示され、針８０２の遠位端８１６は、丸みを帯びているように示されているが、当業者であれば、システム２００及び４００について上記したように、針８０２又は圧力感知装置８０６のいずれかが門脈の壁を穿刺してその中にアクセスを得る為に尖端を含み得ることが理解できる。 As shown in FIG. 21, the system 800 includes a needle 802 and a pressure sensing device 806 that is substantially similar to the above systems (eg, systems 200, 400) and substantially similar to the needle 802 and the pressure sensing device 706. FIG. 21 shows steps 1 and 2 for measuring the pressure in the portal vein into which the pressure sensing device 806 is inserted and / or performing treatment on the portal vein. The needle 802 is substantially identical to the needles 202, 402 and includes a longitudinal channel 808 to which the pressure sensing device 806 is slidably received. The pressure sensing device 806 is approximately identical to the pressure sensing device 706, and is located in a longitudinally extending body 820 of the pressure sensing device 806, for example for the passage of another instrument 860 such as a diagnostic and / or therapeutic instrument. Includes a working channel 852 that extends through. However, the pressure sensor 812 is not fixed in or along the body 820. Rather, the pressure sensor 812 has a first configuration (step 1) in which the pressure sensor 812 is received within the distal end 822 of the body 820, and the pressure sensor 812 exits the distal end 822 and moves distally. The pressure sensor 812, which is connected to the proximal end of the pressure sensing device by the connecting cable 824, is moved laterally away from the distal end 822 as it extends distally out of the distal end 822. It is movably housed in the main body 820 with and from the second configuration (step 2). The distal end 822 of the body 820 is shown to include the tip and the distal end 816 of the needle 802 is shown to be rounded, but for those skilled in the art, for systems 200 and 400. As mentioned above, it can be seen that either the needle 802 or the pressure sensing device 806 may include a tip to puncture the wall of the portal vein and gain access therein.
Claims (4)
前記針のチャンネルの中に摺動可能に挿入される寸法及び形状に形成された長手方向に延びる本体及び前記本体の遠位部分に取り付けられ、且つ接続ケーブルによって圧力感知装置の近位部分に接続されたセンサであって、静脈内の血流の圧力に対応する情報を検出する前記センサを含む圧力感知装置と
を備え、
前記圧力感知装置は、前記センサが前記針の一部によって覆われる挿入形態と、前記圧力感知装置の本体の遠位端が前記針の遠位端を超えて遠位側に延びて前記センサを前記静脈内の流体の流れに露出させる、圧力感知形態との間で、前記針に対して長手方向に移動可能であり、
前記圧力感知装置の本体の遠位端は尖端を含んでおり、前記針の遠位端は丸みを帯びた端を含んでおり、前記挿入形態では、前記圧力感知装置の前記尖端は前記針のチャンネル内に収容され、前記圧力感知形態では、前記圧力感知装置は前記針に対して遠位方向に移動されて前記静脈を穿刺するために前記圧力感知装置の前記尖端を露出し、
前記圧力感知装置の本体は、前記本体の遠位部分を横方向に貫通して延びる穴を含んでおり、前記センサの遠位面が前記穴を通過する前記流体の流れに露出されるように構成されている、静脈内の圧力を測定するためのシステム。 A flexible needle formed in a size and shape such that it can be inserted into the working channel of an endoscope, the needle including a channel extending through the interior in the longitudinal direction.
Attached to a longitudinally extending body and distal portion of the body formed in dimensions and shapes slidably inserted into the needle channel and connected to the proximal portion of the pressure sensor by a connecting cable. A pressure sensor including the sensor that detects information corresponding to the pressure of blood flow in a vein.
Equipped with
The pressure sensing device has an insertion form in which the sensor is covered with a part of the needle, and the distal end of the main body of the pressure sensing device extends distally beyond the distal end of the needle to provide the sensor. It is movable longitudinally with respect to the needle to and from a pressure-sensitive form exposed to the flow of fluid in the vein.
The distal end of the body of the pressure sensing device comprises a tip, the distal end of the needle comprises a rounded end, and in the inserted form, the tip of the pressure sensing device is of the needle. Contained within the channel, in the pressure sensing mode, the pressure sensing device is moved distally to the needle to expose the tip of the pressure sensing device to pierce the vein .
The body of the pressure sensing device includes a hole extending laterally through the distal portion of the body so that the distal surface of the sensor is exposed to the flow of fluid through the hole. A system for measuring intravenous pressure that is configured .
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| US201862728528P | 2018-09-07 | 2018-09-07 | |
| US62/728,528 | 2018-09-07 | ||
| PCT/US2019/047681 WO2020050988A1 (en) | 2018-09-07 | 2019-08-22 | Devices and methods for measuring portal pressure |
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| JP2021530322A JP2021530322A (en) | 2021-11-11 |
| JPWO2020050988A5 true JPWO2020050988A5 (en) | 2022-07-19 |
| JP7203192B2 JP7203192B2 (en) | 2023-01-12 |
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| EP (1) | EP3787489A1 (en) |
| JP (1) | JP7203192B2 (en) |
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- 2019-08-22 WO PCT/US2019/047681 patent/WO2020050988A1/en not_active Ceased
- 2019-08-22 CN CN201980052106.7A patent/CN112533528B/en active Active
- 2019-08-22 CN CN202510141457.2A patent/CN119770011A/en active Pending
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2022
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