CN102271595A - 用于bph的治疗的系统和方法 - Google Patents

用于bph的治疗的系统和方法 Download PDF

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CN102271595A
CN102271595A CN2009801537158A CN200980153715A CN102271595A CN 102271595 A CN102271595 A CN 102271595A CN 2009801537158 A CN2009801537158 A CN 2009801537158A CN 200980153715 A CN200980153715 A CN 200980153715A CN 102271595 A CN102271595 A CN 102271595A
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M·赫伊
J·H·沙德克
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Nxthera Inc
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Abstract

本发明提供了一种前列腺治疗系统，该系统可以包括下列数个特征中的任意一个。该前列腺治疗系统的一个特征是它可以从尿道接近前列腺叶。该前列腺治疗系统的另一个特征是它可以向前列腺输送可冷凝蒸气以使前列腺组织消融。该前列腺治疗系统的又一特征是它可以从前列腺吸取组织。该前列腺治疗系统的再一特征是它可以在输送蒸气和提取组织期间旋转。本发明还覆盖使用该前列腺治疗系统的相关方法。

Description

用于BPH的治疗的系统和方法
相关申请的交叉参考
根据35U.S.C.119，本申请要求于2008年11月6日提交的、名称为“Systems and Methods for Treatment of BPH(用于BPH的治疗的系统和方法)”的美国临时专利申请No.61/112,103的权益。该申请的整体内容结合在此以作参考。
引用结合
本说明书中提到的所有公报和专利申请都通过参考结合于此，引用程度与每个单独公报或专利申请明确且单独地通过引用结合相同。
技术领域
本发明涉及一种用于微创治疗前列腺组织的设备和相关方法。
背景技术
已经开发或提出了若干用于治疗前列腺组织的系统和方法，以减轻BPH症状或治疗前列腺组织。例如，已有基于RF消融、微波消融、高强度聚焦超声波(HIFU)、冷冻消融、辐射、外科手术和近距治疗的组织消融方法。已经开发了利用或不利用机器人辅助的外科手术方法来移除病变的前列腺组织。
这里公开的设备、技术和方法通常适合于治疗前列腺组织，更具体地说，集中于治疗BPH(良性前列腺增生)和前列腺癌。BPH是50多岁左右的男人所经历的涉及尿路梗阻的普遍问题。前列腺增生或前列腺腺体的增大导致尿路压缩并受阻，这导致诸如需要频繁排尿、排尿量降低、遗尿和不舒适之类的症状。
利用电磁能量消融前列腺组织是公知的，并且具有可进行微创治疗的优点。例如，电外科消融或前列腺组织中的高频电流导致细胞破裂或细胞死亡。通过身体伤愈反应产生的组织再吸收随后能够致使可能导致尿路梗阻的组织体积减小。高频电流或激光消融的一个缺陷是潜在的组织碳化，这会导致消融之后炎症反应增加和愈合时间过长。
发明内容
本发明提供了一种从患者的前列腺提取组织的方法，该方法包括：将组织提取构件导入患者尿道内；使该组织提取构件在尿道内旋转；从该组织提取构件注射可冷凝蒸气；以及将前列腺组织吸取(抽吸)到该组织提取构件内。
在一些实施方式中，该方法还包括从组织提取构件向尿道内注射高压液体。高压液体可以以在1脉冲/秒和100脉冲/秒之间的脉冲注射。在一些实施方式中，高压液体从组织提取构件的纵向轴线径向向外地注射。在其他实施方式中，高压液体从组织提取构件的纵向轴线以在10度和90之间的角度注射。
该方法还可包括在注射步骤之前使阻塞构件在组织提取构件蒸气出口端口的远端在尿道内膨胀。该方法还可包括在注射步骤之前使阻塞构件在组织提取构件蒸气出口端口的近端在尿道内膨胀。
在一些实施方式中，旋转步骤包括使组织提取构件以在5rpm和10,000rpm之间(的速度)旋转。所述组织提取构件可以手动旋转，或可以利用动力旋转马达(带动力的旋转马达，电动旋转马达)旋转。
在一些实施方式中，注射可冷凝蒸气包括向前列腺输送在100W和1000W之间(的能量)。在另一实施方式中，注射可冷凝蒸气包括向前列腺输送在100cal/g和600cal/g之间(的能量)。
在一些实施方式中，吸取步骤包括从前列腺移除在10g和50g之间的前列腺组织。
本发明提供了一种前列腺治疗系统，该系统包括：可冷凝蒸气源；以及组织提取构件，该组织提取构件适合于插入成年男性受体的尿道内并在尿道内旋转，所述组织提取构件具有与所述蒸气源连通并适合于将可冷凝蒸气输送至前列腺叶的蒸气输送端口以及适合于将附近的前列腺组织吸取到消融探针内的吸取端口。
所述组织提取构件还可包括与高压液体源连通的液体喷射端口。在一些实施方式中，所述液体喷射端口和高压液体源被构造成适合于以在1脉冲/秒和100脉冲/秒之间的脉冲喷射高压液体。所述液体喷射端口适于并构造成从所述组织提取构件的纵向轴线径向向外地喷射高压液体。在一些实施方式中，所述液体喷射端口适于并构造成从所述组织提取构件的纵向轴线以在10度和90度之间的角度喷射高压液体。在一些实施方式中，所述液体喷射端口与所述蒸气输送端口同心。
该前列腺治疗系统还可包括适合于在所述蒸气输送端口的远端阻塞尿道的远端阻塞构件，以及适合于在所述蒸气输送端口的近端阻塞尿道的近端阻塞构件。
在一些实施方式中，所述前列腺治疗系统还包括动力旋转马达，该马达构造成使组织提取构件以在5rpm和10,000rpm之间(的速度)旋转。
附图说明
图1是蒸气能量输送系统，更具体地说是仪器的手柄部的剖视图，该手柄部具有用于向流体流施加蒸发能量的感应加热组件和用于维持高能蒸气的循环流动的环流系统，该高能蒸气能够根据需要流过延伸构件以与组织相互作用。
图2是图1的感应加热组件的示意图。
图3是患者前列腺和将组织提取构件引入患者尿道内的第一步骤的示意图，其中示出作为提取对象的组织块。
图4是仪器工作端部的立体图。
图5是图4的工作端部的剖面图，其中示意性地示出如何提取和密封组织。
图6是另一个仪器工作端部的示意图。
具体实施方式
本发明提供了一种蒸气能量发生系统，该蒸气能量发生系统能被构造成用于引入患者的尿道或前列腺，或者能被构造成经直肠或利用内窥镜进入前列腺组织。该系统构造成将加热的蒸气例如水蒸气输送至组织，如在下面的待审美国专利申请中描述的那样：于2003年10月7日提交的名称为“Medical Instruments and Techniques for Thermally-mediatedTherapies(用于热介入疗法的医疗仪器和技术)”的美国专利申请No.10/681,625，于2005年6月22日提交的名称为“Medical Instruments andTecchniques for Treating Pulmonary Disorders(用于治疗肺部疾病的医疗仪器和技术)”的美国专利申请No.11/158,930，于2005年10月5日提交的名称为“Medical Instrument and Method of Use(医疗仪器和使用方法)”的美国专利申请No.11/244,329以及于2006年1月10日提交的名称为“Medical Instrument and Method of Use(医疗仪器和使用方法)”的美国专利申请No.11/329,381。
用于各种治疗程序的可压缩高能蒸气的产生和输送在共同未决的美国专利申请No.60/929,632、No.61/066,396、No.61/068,049中的具有“远程”蒸气发生系统或源或者具有位于手柄或工作端部中的蒸气发生器或者二者的组合的系统中进一步公开，如在临时专利申请No.61/068,130、No.61/123,384、No.61/123,412、No.61/126,651、No.61/126,612、No.61/126,636和No.61/126,620中所述的。
图1示出具有手柄802的蒸气能量发生系统800，手柄802包括与临时申请No.61/123,416、No.61/123,417和No.61/126,647中描述的系统类似的感应加热系统。在图1中，手柄802通过耐热配件806联接至流体源810，该流体源810以受控的流量和压力输送液体。液体流经过联接至电源和控制器820的蒸气发生感应加热器805。该系统和手柄构造用于循环的液体/蒸气流，以便向工作端部或退出通道822提供蒸气，由此将蒸气输送至组织位置。该系统具有可以与收集储存器830和/或负压源835连通的以附图标记824表示的流入通道和以附图标记826表示的流出通道。在流出通道826中设置有例如通过脚踏开关操作的阀836，以将蒸气重新引导到退出通道822和延伸构件840。
图1所示的蒸气能量发生系统800可用于任何外科手术/医疗应用，其中延伸构件840包括针、细长探针或柔性导管和其他类似的细长输送装置。该系统可以用于输送能量的导管，以用于血管内应用、用于治疗呼吸道紊乱、用于子宫内膜消融治疗或用于针消融治疗。在图1的实施例中，示出了可选的第二加热器845，其具有同心的绝缘器846。该第二加热器能够向开始流过退出通道822的蒸气提供更多的蒸发能量。第二加热器可以是感应加热器或电阻加热器，其利用多微孔材料以提供大表面面积，以便向蒸气施加能量从而移除任何水滴。该系统能够提供至少为90％的水蒸气的蒸气。该第二加热器通过电导线(未示出)操作地联接至电源和控制器820。
图2示出了蒸气发生感应加热器805，在一个实施方式中，该加热器包括其中具有孔852的陶瓷柱体850。陶瓷柱体850可以例如大约长度为1.0英寸至1.5英寸，直径为0.25英寸，孔852为0.10英寸。孔852填充有多个小直径的海波管(hypotube)855，所述海波管是磁响应的，例如为316不锈钢。在一个实施例中，海波管855是0.016薄壁管。围绕陶瓷柱体850设置有轴向长度大约1.0英寸的一至十层的绕组860，以便利用来自电源的极高频电流在海波管855中感应出热。在一个实施例中，绕组860可以是具有特氟龙涂层的26Ga的铜线。已经发现，利用适当流量的水输送至少50W、100W、200W、300W或400W能够产生非常高的质量的蒸气，例如90％及更好的蒸气。
在图2中，可以看到，感应加热的海波管855’还可以被螺旋切割，以便为这种将定位在导管或探针工作端部中的感应加热器提供灵活性(柔性)。例如，这种柔性可加热元件可以被装载在柔性耐高温聚合绝缘构件的孔中，从而提供构造成用于血管内导航的柔性导管。围绕感应加热器的外部的绝缘层没有示出。通常，蒸气发生感应加热器805能够被构造成提供在蒸气质量、来自工作端部的出口蒸气压力、出口蒸气温度方面具有精确参数的高质量可冷凝蒸气，以及在治疗间隔上将所述参数维持在严格的范围内。所有这些参数都能够以高水平精度进行控制以获得受控剂量，无论具体治疗在治疗间隔上要求极低压力(例如1-5psi)或极高压力(200psi或更大)，并且不管治疗间隔是1-10秒还是2-5分钟。
现在参照图3，示出了患者尿道105和前列腺106的截面示意图，其中仪器轴利用成像系统(未示出)导航至患者尿道中的预定部位。成像系统可以以通道中的观测仪器或CCD的形式提供。用于按体积移除前列腺组织的系统在图3中示出，该系统具有细长组织提取构件405，该提取构件405的工作端部410以经尿道方式前进到患者前列腺的内部中。相对的前列腺叶中的以420A和420B表示的组织区域可以作为移除目标。该系统还能够同时热封所提取的组织块的边缘。可以设置冲洗系统(未示出)以向管腔供应流体。
图4示出，组织提取构件405和工作端部410可以是刚性或略微柔性的组件，它具有范围从约2mm到10mm的直径。该组织提取构件可以包括与蒸气源100连通的至少一个蒸气输送端口444，并且能够适合于向前列腺叶输送可冷凝蒸气。该组织提取构件还可以具有至少一个吸取端口480，该吸取端口与负压源470连通，并适合于将邻近的前列腺组织吸取到组织提取构件内。在一个实施方式中，该组织提取构件构造成用于在TURP之类的手术中从液体介质源450喷射至少一种流体或蒸气介质中的一个，并用于向界面组织施加机械能和热能以消融尿道组织和邻近组织并按体积将这些组织移除。
工作端部可以承载可选的阻塞构件422a和422b，所述阻塞构件可通过流体膨胀源425扩张。所述阻塞构件可以位于组织提取构件的近端部分和远端部分上。远端阻塞构件422b适合于在蒸气输送端口444的远端阻塞尿道，近端阻塞构件422a适合于在蒸气输送端口的近端的阻塞尿道。
工作端部的中央部430构造成在体腔内旋转。该工作端部的旋转可以是手动的(例如，通过内科医生使仪器进行物理旋转)，或另选地，可以将旋转机构186(例如动力旋转马达)联接至工作端部125，以使装置的远端在消融和吸取过程中自动地旋转。该旋转机构可以构造成使消融探针以例如5rpm至10,000rpm旋转。在美国专利申请No.12/389,808和No.61/123,416中描述了使消融探针在组织中旋转的方法的更多细节，这两个申请结合在此以作参考。
图5示出仪器工作端部410的剖视图，其中可以看出设有第一流体流系统或可冷凝蒸气源100(例如如图1所示)，并使该第一流体流系统或可冷凝蒸气源流体联接至至少一个蒸气流入通道452，该流入通道452延伸至工作端部的至少一个凹部445中的至少一个蒸气输送端口444。在该实施方式中，各个蒸气输送端口的轴线相对于仪器的轴线448轴向地指向，或者另选地，该轴线可以相对于组织提取构件的纵向轴线448以大约10°到90°的角从装置轴线448向外径向指向。
仍然参照图5，仪器工作端部410包括第二流体流系统，该第二流体流系统包括高压液体源450，该高压液体源450流体联接至至少一个蒸气流入通道440，该通道440延伸至工作端部的至少一个凹部445中的至少一个液体喷射端口460。在该实施方式中，每个液体喷射端口的轴线都可以相对于仪器的轴线448基本上轴向地指向，或者另选地，该轴线可以相对于组织提取构件的纵向轴线448以大约10°到90°的角从装置轴线448向外径向指向。
如可从图5中看出的，仪器工作端部410还包括组织提取通道465，该组织提取通道联接至负压源470以用于从治疗部位提取分解的组织、水和冷凝的蒸气介质。计算机控制器475操作地联接至各种系统和源100、450和470以允许协调操作。
参照图5，仪器工作端部410可以起动吸取或负压源470和控制器475，以将组织抽吸到工作端部凹部445和吸取端口480中，其中在旋转操作中，可以理解的是，蒸气从出口444高压喷射将导致蛋白质和组织成分的热损坏、削弱和变性。同时，从出口460高压喷射液流介质可以分解并破坏被热损坏和削弱的组织以允许通过端口480将其提取。同时，蒸气流及其相变能量释放同时将组织边缘密封或凝结以防止出血。治疗之后，身体的伤愈反应将使尿道像TURP手术中常见的那样愈合。
应该看到，工作端口可以具有一个或多个用于流体喷射以提取组织的结构，并且可以被旋转地或轴向地致动。在一个实施方式中，该系统可以构造成仅围绕组织的选定的径向角例如管腔的5°、15°、30°、45°、60°、90°向组织施加能量。类似地，组织消融和提取可以具有任何轴向取向，例如消融和提取组织的线性部分。
在另一方法中，如图4至5所示的工作端部可以不设置球囊，并且可以经间质引入以提取前列腺组织的核。
在另一实施例中，可以利用单个流体喷射端口，其中蒸气质量使得蒸气和同一流中的水滴能够施加足够的机械力以分解并按体积移除蒸气与组织界面处的组织。因而，在本发明的一个方面中，蒸气质量，或喷射的蒸气和喷射的水滴的组合能够切断热削弱的组织。在另一方法中，流体喷射以1至100脉冲/秒的速率脉动。在另一实施方式中，流体喷射利用水和蒸气的间歇脉冲以高重复率脉动，其中喷射的水量能够将组织分解并且蒸气量配置成削弱组织并将组织热密封。
图6示出工作表面部分的另一实施方式，其中蒸气输送端口490同心地围绕液体喷射端口495，以与组织相互作用并将组织消融。出口可以构造成用于消融组织的任何类型的表面结构，例如图4和图5的工作端部的凹部。
通常，用于治疗(处理)前列腺病变的方法包括：在通过从装置工作端部喷射被喷射的液体和加热的可冷凝蒸气执行的方法中与分解组织的吸取一起地按体积移除尿道及周围的前列腺组织。在本发明的一个方面中，蒸气介质的喷射施加足够的热能以基本改变组织，其中所述改变至少包括削弱共价键、使蛋白质变性和破坏胶原质结构至少之一。另外，流体介质喷射施加足够的机械能以移除组织，其中移除包括对组织进行分解、切割、切除和消融至少之一。在本发明的另一方面中，流体介质喷射施加足够的热能以热密封或凝结被移除的组织边缘。另外，按体积移除组织的方法能够与成像例如超声成像同时地进行。
通常，用于密封所提取组织的组织边缘的方法通过从装置工作端部注射可冷凝蒸气和吸取分解组织来完成，其中，来自蒸气的能量包括向组织输送至少100W、250W、500W和1000W。在另一个实施方式中，注射可冷凝蒸气包括以100cal/g至600cal/g输送至前列腺。
通常，治疗BPH的方法包括按体积移除等于至少1g、10g、至少20g、至少30g、至少40g、至少50g和至少100g组织的前列腺组织。
从患者前列腺提取组织的方法的一个实施方式包括将组织提取构件引入患者尿道内，在尿道内旋转该组织提取构件，从组织提取构件注射可冷凝的蒸气，并且将前列腺组织吸取到组织提取构件内。旋转步骤可包括例如利用例如动力旋转马达使组织提取构件以5rpm至10,000rpm旋转。在另一实施方式中，可以手动地使组织提取构件旋转。
该方法可以进一步包括从组织提取构件将高压液体注射到尿道内。高压液体的注射可以以1脉冲/秒至100脉动/秒的脉冲注射。在一些实施方式中，高压液体可以从组织提取构件的纵向轴线沿径向向外注射。在其他实施方式中，高压液体可以从组织提取构件的纵向轴线以10度至90度的角度注射。
在所述方法的一些实施方式中，阻塞构件在组织提取构件蒸气出口端口的远端在尿道内膨胀。该步骤可以在例如从组织提取构件注射可冷凝蒸气之前执行。在另一实施方式中，阻塞构件在组织提取构件蒸气出口端口的近端在尿道内膨胀，该步骤可以例如在从组织提取构件注射可冷凝蒸气之前执行。
在另一实施方式中，可以与上述蒸气喷射同时地使用高速旋转切割器，以使所移除组织周围的边缘热凝结。
本发明的系统包括：具有工作端部的细长组织提取构件，用于移除患者前列腺中的尿道组织；与远端中的蒸气输送端口流体连通的蒸气源；用于从工作端部喷射高压液体的液体喷射源；以及负压源，该负压源联接至与工作端部中的紧接蒸气输送端口的组织提取端口流体连通的通道。所述端口相对于组织提取构件的轴线可以较远地定向，或相对于组织提取构件的轴线成一定角度地定向，或与组织提取构件的轴线基本平行地在组织提取构件的一侧定向。
通常，本发明的方法包括输送可冷凝蒸气，该可冷凝蒸气经受相变以提供至少100cal/g、250cal/g、300cal/g、350cal/g、400cal/g、450cal/g和600cal/g的施加蒸气能量。
在本发明的另一方面中，利用蒸气治疗可以在适当类型的成像下完成。在一个方法中，该步骤可以通过超声或X射线成像观察。在一个方法中，本发明的导入器导入和能量输送方法可以通过利用经过直肠的超声系统通过超声成像。
在本发明的另一方面中，该系统可以同时用于将流体输送前列腺内的目标位置以用于治疗目的，例如用于一般或局部药物输送、化疗或可通过蒸气或热起动的其他制剂的喷射。
尽管以上已经详细地描述了本发明的具体实施例，但应理解，该描述仅仅是出于示例的目的，并且本发明的上述描述不是穷尽的。本发明的特定特征在一些附图中示出但没有在其他附图中示出，这仅仅是为了方便，根据本发明任一特征都可以与另一特征组合。对本领域普通技术人员来说许多变型和替代方案都是明显的。这些替代方案和变型都应包含在权利要求的范围内。在从属权利要求中呈现的具体特征可以进行组合并且落入本发明的范围内。本发明还涵盖引用其他独立权利要求另选地以多项从属权利要求格式撰写的从属权利要求的实施方式。

Claims (23)

1.一种从患者的前列腺提取组织的方法，该方法包括：
将组织提取构件导入患者的尿道内；
使所述组织提取构件在尿道内旋转；
从所述组织提取构件注射可冷凝蒸气；以及
将前列腺组织吸取到所述组织提取构件内。
2.根据权利要求1所述的方法，其特征在于，该方法还包括从所述组织提取构件向尿道内注射高压液体。
3.根据权利要求2所述的方法，其特征在于，注射高压液体的步骤包括以1脉冲/秒至100脉冲/秒的脉冲注射高压液体。
4.根据权利要求2所述的方法，其特征在于，注射高压液体的步骤包括从所述组织提取构件的纵向轴线沿径向向外地注射高压液体。
5.根据权利要求2所述的方法，其特征在于，注射高压液体的步骤包括从所述组织提取构件以10度至90度的角度注射高压液体。
6.根据权利要求1所述的方法，其特征在于，该方法还包括在注射步骤之前使阻塞构件在组织提取构件的蒸气出口端口的远端在尿道内膨胀。
7.根据权利要求1所述的方法，其特征在于，该方法还包括在注射步骤之前使阻塞构件在组织提取构件的蒸气出口端口的近端在尿道内膨胀。
8.根据权利要求1所述的方法，其特征在于，旋转步骤包括使所述组织提取构件以5rpm至10,000rpm旋转。
9.根据权利要求1所述的方法，其特征在于，旋转步骤包括手动旋转所述组织提取构件。
10.根据权利要求1所述的方法，其特征在于，旋转步骤包括利用动力旋转马达旋转所述组织提取构件。
11.根据权利要求1所述的方法，其特征在于，该方法还包括将所提取的组织周围的组织边缘热封。
12.根据权利要求1所述的方法，其特征在于，注射可冷凝蒸气包括将100W至1000W输送至前列腺。
13.根据权利要求1所述的方法，其特征在于，注射可冷凝蒸气包括以250cal/g至450cal/g输送至前列腺。
14.根据权利要求1所述的方法，其特征在于，吸取步骤包括从前列腺移除10g至50g的前列腺组织。
15.一种前列腺治疗系统，包括：
可冷凝蒸气源；以及
组织提取构件，该组织提取构件适合于插入成年男性受体的尿道内并在尿道内旋转，
该组织提取构件具有蒸气输送端口和吸取端口，该蒸气输送端口与该蒸气源连通并适合于将可冷凝蒸气输送至前列腺叶，该吸取端口适合于将附近的前列腺组织吸取到消融探针内。
16.根据权利要求15所述的系统，其特征在于，所述组织提取构件还包括液体喷射端口，该液体喷射端口与高压液体源连通。
17.根据权利要求16所述的系统，其特征在于，该液体喷射端口和高压液体源构造成适于以1脉冲/秒至100脉冲/秒的脉冲喷射高压液体。
18.根据权利要求16所述的系统，其特征在于，该液体喷射端口构造成适合于从所述组织提取构件的纵向轴线沿径向向外喷射高压液体。
19.根据权利要求16所述的系统，其特征在于，该液体喷射端口构造成适合于从组织提取构件的纵向轴线以10度至90度的角度喷射高压液体。
20.根据权利要求16所述的系统，其特征在于，该液体喷射端口与该蒸气输送端口同心。
21.根据权利要求15所述的系统，其特征在于，该系统还包括远端阻塞构件，该远端阻塞构件适于在该蒸气输送端口的远端阻塞尿道。
22.根据权利要求15所述的系统，其特征在于，该系统还包括近端阻塞构件，该近端阻塞构件适于在该蒸气输送端口的近端阻塞尿道。
23.根据权利要求15所述的系统，其特征在于，还包括动力旋转马达，该动力旋转马达构造成使组织提取构件以5rpm至10,000rpm旋转。
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