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    • 专利摘要:
    The invention relates to a system (1) for the treatment of an epistaxis comprising: - a compressible member (20, 120) configured to come into contact with the walls of a nasal cavity of a patient, or surrounded by a haemostatic properties veil, - an envelope (30, 130) configured to envelop the compressible member (20, 120), and - a compressing device (10, 110) of the compressible member (20, 130) in the envelope, said compression device being configured to bring the compressible member (20, 120) into its compressed or deployed configuration.
    公开号:FR3041237A1
    申请号:FR1650205
    申请日:2016-01-11
    公开日:2017-03-24
    发明作者:Patrick Lestoquoy
    申请人:Vygon SA；
    IPC主号:
    专利说明:

    FIELD OF THE INVENTION The invention relates to the field of medical devices for controlling nasal discharge or haemorrhage of nasal cavities (or epistaxis).
    BACKGROUND
    An epistaxis is a bloody discharge from the nasal cavity. This bleeding is very common and mostly benign. In some cases, however, it can become, by its abundance, its repetition or the fragility of the ground a true medical and surgical urgency.
    Thus, suitable systems have been proposed for absorbing blood and compressing vasoconstriction against the walls of nasal cavities are introduced into the patient's nasal cavity, in order to treat these epistaxis.
    For example, there are wicks with hemostasis properties and made of an expandable material configured to fill the nasal cavity. Typically, the locks can be made of oxidized regenerated cellulose, and thus be hemostatic per se, or in a non-hemostatic expandable material, such as polyvinyl alcohol. However, such locks are traumatic at the introduction and withdrawal, despite their possible re-wetting before withdrawal. In addition, a significant risk of secondary haemorrhage due to uncontrolled tearing of the wick persists at the junction point of the haemostasis.
    Also known are inflatable balloon systems comprising a first configuration, wherein the balloon is deflated to be inserted into the nasal cavity, and a second configuration in which the balloon is inflated to apply pressure against the nasal cavity and stop the bleeding. However, these systems are particularly uncomfortable for the patient because of the significant pressure applied by the balloon to stop the bleeding, knowing that this pressure is often greater than necessary to ensure that the balloon adapts to the physiognomy of the patient. the nasal cavity of the patient. Moreover, these systems do not exhibit rapid hemostasis effect. In addition, these systems comprising an inflatable balloon are flexible and are therefore difficult to introduce and position accurately in a nasal cavity of a patient.
    SUMMARY OF THE INVENTION
    An object of the invention is therefore to propose a system for the treatment of an epistaxis which makes it possible to stop a nasal hemorrhage without risk of secondary haemorrhage at the junction point of the haemostasis by applying a controlled pressure on the walls of the a nasal cavity of a patient and which is furthermore simple to implement while being more ergonomic and less traumatic for the patient than the systems of the prior art.
    For this purpose, the invention proposes a system for the treatment of an epistaxis comprising: a compressible shape memory member having a compressed configuration, in which the compressible member is compressed and is configured to be introduced into a nasal cavity of a patient, and an expanded configuration, in which the compressible member is deployed and is configured to contact walls of the patient's nasal cavity, a casing configured to envelop the compressible member, and a device for compression of the compressible member in the envelope, said compression device being configured to bring the compressible member into its compressed or deployed configuration.
    Some preferred but non-limiting features of the system described above are the following, taken individually or in combination: the compression device comprises an implantation tube, configured to be inserted into the nasal cavity of a patient, said tube of implant having a proximal end, a distal end and a central through passage extending between the proximal end and the distal end, and said compressible member being configured to be housed in the central passage of the implantation tube in a compressed configuration , and a fastener configured to be attached to the envelope and protrude from the proximal end of the implantation tube when the compressible member is housed in the central passage, to facilitate introduction of the compressible member and the envelope in the implantation tube when the compressible member is in configuration e xpansée, - the envelope comprises a net or a film. the envelope is configured to hermetically enclose the compressible member so as to form a sealed enclosure, and the compression device is configured to reduce a pressure in the assembly formed of the compressible member enclosed in the envelope so as to bringing the compressible member into its compressed configuration, the envelope comprises a flexible film, the envelope comprises a polyethylene film and / or a polyurethane film, said envelope possibly having a thickness of between a few microns and a hundred microns, the compression device comprises a syringe or a partial evacuation member,
    the compressible member has a proximal end near which the compression device is fixed and a distal end opposite the proximal end, a central recess being formed between the proximal end and the distal end of the compressible member; and the system further comprising a tube, housed in the central recess, I - the tube is configured to be in fluid communication with the compression device to reduce the pressure in the compressible member, through orifices being formed in the tube between the proximal end and the distal end of the compressible member to allow for progressive compression and expansion of the compressible member over its entire length, - the system further comprises a latch comprising a first fastener attached to a proximal end of the tube and a second complementary fastener attached to the compression device, - the tube projects from the compressible member and comprises a fin configured to be fixed on an area of the body of a patient, and / or - the system further comprises a veil having hemostatic properties covering envelope, said web may comprise a nonwoven web having an acidic pH to impart hemostatic properties thereto.
    According to a second aspect, the invention provides an assembly for the treatment of an epistaxis, comprising: a compressible member having a compressed configuration, wherein the compressible member is compressed and is configured to be introduced into a nasal cavity of a patient, and an expanded configuration, in which the compressible member is deployed and is configured to come into contact with walls of the nasal cavity of the patient, and - an envelope, said envelope surrounding the compressible member and being fixed on said organ compressible so as to form a sealed enclosure.
    This set is configured to be implemented in a system for treating an epistaxis as described above.
    According to a third aspect, the invention also proposes a system for the treatment of an epistaxis comprising: - an implantation tube, configured to be introduced into a nasal cavity of a patient, said implantation tube having a proximal end, a distal end and a central through passage extending between the proximal end and the distal end, - a compressible member having hemostatic properties, said compressible member having a compressed configuration, wherein the compressible member is compressed and is configured to be housed in the central passage of the implantation tube, and an expanded configuration, in which the compressible member is deployed and is configured to come into contact with walls of the patient's nasal cavity, - a configured envelope to wrap the compressible member, and - a fastener configured to be attached to the e nvelops and protrudes from the proximal end of the implantation tube when the compressible member is housed in the central passage, to facilitate the introduction of the compressible member and the envelope into the implantation tube when the compressible member is in expanded configuration.
    Certain preferred but non-limiting features of the system for the treatment of an epistaxis according to the third aspect of the invention are the following, taken individually or in combination: the fastener is configured to extend into the central passage and protrude of the proximal end of the implantation tube when the compressible member and the envelope are at least partially housed in the implantation tube, the fastener comprises at least one strand or an instrument comprising a hook or a clamp, the envelope comprises a net, the net comprises a material having anticoagulation properties, the compressible member comprises a foam, for example an oxidized regenerated cellulose foam having hemostatic properties, a foam made of a material which does not exhibit Hemostatic properties wrapped in a veil made of oxidized regenerated cellulose p resonant hemostatic properties or a foam made of a material having no hemostatic properties imbibed with a fluid having hemostatic properties, the envelope comprises a film, the system further comprises a haze having hemostatic properties covering envelope, said web may comprise a nonwoven web having an acidic pH in order to impart hemostatic properties thereto, the compressible member and the implantation tube have a generally cylindrical shape, preferably a cylindrical shape of revolution, the system comprises further a catheter and the compressible member has a central recess configured to slidably receive said catheter; the catheter includes a proximal end configured to be in fluid communication with a fluid reservoir, and a distal end opposite the catheter; proximal end and in the An injection port is formed, said injection port being in fluid communication with the proximal end, and / or - the system further comprises a mandrel configured to be housed in the implantation tube for urging compressible member of the distal end of said implantation tube and thus allow removal of the implantation tube.
    According to a fourth aspect, the invention also proposes an assembly for the treatment of an epistaxis comprising: a compressible member having hemostatic properties, said compressible member having a compressed configuration, in which the compressible member is compressed and is configured to being housed in the central passage of the implantation tube of a system according to the third aspect of the invention, and an expanded configuration, in which the compressible member is deployed and is configured to come into contact with walls of the cavity nasal patient, - an envelope configured to envelop the compressible member, and - a fastener configured to be attached to the envelope and protrude from the proximal end of the implantation tube when the compressible member is housed in the passageway central, to facilitate the introduction of the compressible member and the envelope in the implant tube when the compressible member is in an expanded configuration.
    BRIEF DESCRIPTION OF THE DRAWINGS Other features, objects and advantages of the present invention will appear better on reading the detailed description which follows, and with reference to the appended drawings given by way of non-limiting examples and in which:
    FIG. 1 is a longitudinal sectional view of an exemplary embodiment of an epistaxis treatment system according to a first embodiment of the invention,
    FIG. 2 is a perspective view of an exemplary embodiment of a compressible member wrapped in an envelope of a system according to the first embodiment of the invention,
    FIG. 3 is a perspective view of the compressible member of FIG. 2,
    FIG. 4 is a side view of an exemplary embodiment of a catheter that can be used in a treatment system according to the first embodiment of the invention,
    FIG. 5 is a side view of an exemplary embodiment of a mandrel that can be used with a processing system according to the first embodiment of the invention,
    FIG. 6 is a partial side view of a first exemplary embodiment of an epistaxis treatment system according to a second embodiment of the invention,
    FIG. 7 is a sectional view of the processing system of FIG. 6 along axis A-A,
    Figure 8 is a side view of a second embodiment of an epistaxis treatment system according to the second embodiment of the invention.
    DETAILED DESCRIPTION OF AN EMBODIMENT
    In what follows, "proximal" designate a part that is close to the operator when it uses the system of the invention.
    In order to ensure the arrest of an epistaxis in a nasal cavity of a patient, the invention proposes a system 1 for the treatment of an epistaxis comprising: a compressible member 20, 120 having a compressed configuration, in which the compressible member 20, 120 is compressed and is configured to be inserted into a nasal cavity of a patient, and an expanded configuration, in which the compressible member 20, 120 is deployed and is configured to contact walls of the nasal cavity of the patient, - an envelope 30, 130 configured to envelop the compressible member 20, 120, and - a compression device 10, 110 of the compressible member 20, 120 in the envelope 30, 130, said compression device 10, 110 being configured to bring the compressible member 20, 120 into its compressed or deployed configuration. The compressible member 20, 120 has a shape adapted to fit, in expanded configuration, the shape of the nasal cavity of the patient. For example, the compressible member 20, 120 may be of substantially cylindrical shape (of square section, parallelepipedal, oval, round, etc.), or even cylindrical of revolution, or alternatively may have a non-uniform section between its distal end 24 , 124 and its proximal end 22, 122. Typically the compressible member 20, 120 may have a narrower distal portion and an enlarged proximal portion.
    In expanded configuration, the compressible member 20, 120 has a periphery having an average width L of between twenty and forty millimeters. Per periphery width L, here will be understood the distance between two parallel lines (or "support lines") which are tangent to the closed curve formed by the periphery of the sensor at two distinct points. For example, for a compressible member 20, 120 cylindrical of revolution, the average width L is equal to the outer diameter of the cylinder. The compressible member 20, 120 may in particular be made of a compressible material with shape memory such as a foam, which may especially have a density of 25 kg / m3.
    Unlike systems of the prior art using an inflatable balloon, the compressible member 20, 120 of the invention is in an expanded configuration when it is at rest. The pressure applied by the compressible member 20, 120 is therefore easy to control and results from the material chosen to produce it. The envelope 30, 130 may take the form of a flat sheet and be wrapped around the compressible member 20, 120. In a variant, the envelope 30, 130 may have the general shape of a shaped sleeve in order to be able to be fitted in a manner fitted to the compressible member 20, 120. In particular, the dimensions of the casing 30, 130 in the form of a sleeve can be adjusted to the dimensions and to the shape of the compressible member 20, 120 so as to limit the formation of folds, which would form extra thicknesses likely to create discomfort for the patient. For example, for a compressible member 20, 120 of cylindrical shape of revolution in an expanded configuration, the envelope 30, 130 may have a cylindrical shape of revolution whose external diameter is substantially equal to the external diameter of the compressible member 20.
    The compression device 10, 110 may comprise a member 10 configured to compress, externally, the compressible member in order to easily introduce and remove it from a nasal cavity of a patient (first embodiment) . The compression device 10, 110 may otherwise comprise a member 110 configured to compress, from the inside (by suction of air into the compressible member 120), the compressible member 120 (second embodiment).
    First embodiment: compressing the outside of the compressible organ
    In this first embodiment, illustrated with reference to Figures 1 to 5, the compression device comprises an implantation tube 10, configured to be introduced into the patient's nasal cavity, said implantation tube 10 having a proximal end 12 , a distal end 14 and a central through passage 16 extending between the proximal end 12 and the distal end 14.
    Furthermore, the compressible member 20 has hemostatic properties. Finally, the system further comprises a clip 40 configured to be fixed on the casing 30 and projecting from the proximal end 12 of the implantation tube 10 when the compressible member 20 is housed in the central passage 16, in order to facilitate the introduction of the compressible member 20 and the envelope 30 into the implantation tube 10 when the compressible member 20 is in an expanded configuration. The compressible member 20 may in particular be made of a compressible memory-shape material such as a foam, typically an oxidized regenerated cellulose foam having hemostatic properties, an inert foam - that is to say made of a material having no haemostatic properties - wrapped in a haze made of an oxidized regenerated cellulose having haemostatic properties, or an inert foam soaked in a fluid having haemostatic properties. In an exemplary embodiment, the compressible member 20 comprises a polyurethane foam having a density of 25 kg / m 3 having open cells wrapped in a nonwoven having an acidic pH in order to impart hemostatic properties to the compressible member. In another embodiment, the compressible member 20 comprises an oxidized regenerated cellulose sponge, which has hemostatic properties. In this case, in order to ensure that the sponge 20 can adopt a compressed configuration and an expanded configuration, the cellulose sponge 20 can in particular be treated with a plasticizer, such as magnesium chloride salts. . The purpose of the envelope 30 is to allow, by means of the fastener 40, the reintroduction of the compressible member 20 into the implantation tube 10, when the compressible member 20 is in an expanded configuration.
    In a first embodiment, the envelope 30 comprises a net. The net 30 has mesh sufficiently large to allow the realization of hemostasis in the nasal cavity, but small enough to maintain the compressible member 20 when introduced into the nasal cavity. Typically, the net 30 may have a mesh comprising meshes having a size of between two and five millimeters.
    The net 30 may be made of an inert material.
    Alternatively, the mesh 30 may be chemically treated to exhibit anticoagulant properties. In this way, the anticoagulant treatment makes it possible to limit the adhesion of the net 30 to the walls in the discrete zones of the wall against which the thread 30 is in contact, and thus to facilitate the removal of the compressible member 20 in a less traumatic manner. for the patient.
    In a second embodiment, the envelope 30 comprises a flexible film.
    Preferably, the envelope 30 is made of a non-elastic material. For example, the envelope 30 may be made of polyamide, polyethylene or polyurethane. The fastener 40 may be integrally formed with the envelope 30 or attached and fixed on the envelope 30.
    In one exemplary embodiment, as can be seen in FIG. 2, the fastener 40 may comprise one or more flexible strands attached to the proximal end 32 of the envelope 30.
    Alternatively, the clip 40 may comprise a rigid instrument comprising a hook or clamp attached to the free end of a rigid rod which may be made of metal or a plastic material. In the case where the envelope 30 comprises a net, the hook or the clamp of the instrument can then be introduced into one or more meshes of the net 30 while its proximal end 32 remains accessible to an operator at the level of the proximal end 12 of the implantation tube 10.
    Whatever the embodiment, the traction with the fastener 40 on the casing 30, which surrounds the compressible member 20, makes it possible to progressively detach the compressible member 20 from the walls of the nasal cavity and to gradually bring it into a compressed configuration from its proximal end 22 towards its distal end 24 by reintroducing it into the implantation tube 10. Unlike the conventional wicks, the compressible member 20 is thus detached from near, and not detached. in a single block of the walls of the cavity, thereby reducing the trauma suffered by the patient. Once the compressible member 20 is completely inserted into the implantation tube 10, the latter is in a compressed configuration, in which its bulk is reduced. The extraction of the compressible member 20 is therefore easier for an operator and more comfortable for the patient than in the prior art, where the locks are extracted while they are soaked with blood and have a maximum size.
    The implantation tube 10 has a substantially cylindrical shape, for example cylindrical of revolution. The distal end 14 of the implantation tube 10 may be flared to facilitate the reintroduction of the compressible member 20 for progressive compression. The proximal end 12 of the implantation tube 10 may comprise a handle equipped with a guard.
    The inner diameter of the central passage 16 may be between six and twelve millimeters.
    Where appropriate, the implantation tube 10 may have, at its periphery, graduations or marks to facilitate its positioning in the nasal cavity.
    Optionally, the system 1 may further comprise a catheter 50. The catheter 50 may in particular allow rehumidification of the compressible member 20 and / or injection of anesthetic product into the nasal cavity before removal of the compressible organ 20 of the nasal cavity. For this purpose, the compressible member 20 may in particular comprise a central recess 26 passing through, extending between the proximal end 22 and the distal end 24 of the member 20 and configured to slidably receive the catheter 50. In the In the case of a cylindrical compressible member 20 of revolution, the central recess 26 extends parallel to the axis of revolution of the compressible member 20.
    The catheter 50 may include a proximal end 52, configured to be in fluid communication with a fluid reservoir, and a distal end 54, opposed to the proximal end 52, for insertion into the central recess 26 of the compressible member 20. The catheter 50 may be single lumen and include a central through lumen extending between its proximal end 52 and its distal end 54, or alternatively be multi-lumen and include several lumens therethrough.
    In one embodiment, the catheter 50 is single-lumen and includes an injection port 56 at its distal end 54. Such a catheter 50 then allows the injection of an anesthetic product prior to the placement of the compressible member 20 and / or the injection of a product to soften the compressible member 20 prior to its removal.
    Alternatively or in addition, the catheter 50 may be single-lumen and include a plurality of injection orifices 56 formed at its periphery and distributed between its distal end 54 and its proximal end 52 in order to allow the injection of a fluid on the along the central recess 26 of the compressible member 20.
    Optionally, the catheter 50 may be equipped with graduations or colorimetric marks to allow its precise positioning in the compressible member 20. For example, the catheter 50 may comprise graduations or marks at regular intervals, typically every centimeter, on a section adjacent to its distal end 54 or over its entire length.
    The catheter 50 can then be used to inject a product having hemostatic properties into the compressible member 20 prior to its implantation in the nasal cavity, in particular when the compressible member 20 is made of a material having no such properties. In this case, a catheter 50 provided at its periphery with a series of injection orifices 56 distributed on a section adjacent to its distal end 54 makes it possible to effectively and controllably imbibe the compressible member 20.
    The system 1 for the treatment of an epistaxis according to this first embodiment can then be implemented as follows.
    In a first embodiment, the system 1 for the treatment of an epistaxis can be provided in kit form. The system 1 must then be mounted prior to its use. For this purpose, a compressible member 20 is firstly enveloped or introduced into an envelope 30. At this stage of the assembly, the compressible member 20 is in deployed configuration. The envelope 30 may be pre-fitted with a fastener 40. In a variant, a fastener 40 may be fastened to the envelope 30. The assembly formed by the compressible member 20, the envelope 30 and the fastener 40 is then introduced into an implantation tube 10. For example, the fastener 40 can be introduced into the implantation tube 10 by its distal end 14, then the compressible member 20 - which is then in deployed configuration - is compressed and gradually introduced with the envelope 30 into the implantation tube 10 by its distal end 14 by applying a tensile force on the fastener 40 from the proximal end 12 of the implantation tube 10. Once the compressible member 20 integrally introduced into the implantation tube 10, it is then in compressed configuration.
    Alternatively, the compressible member 20 and the fastener 40 may also be introduced into the implantation tube 10 by its proximal end 12. In this case, the compressible member 20 and the fastener 40 may be moved and brought into position. position of use in the implantation tube 10 with a mandrel 60.
    In a second embodiment, the system 1 may be partially preassembled, the compressible member 20 being wrapped in the envelope 30 but separated from the implantation tube 10. In this case, the assembly formed by the compressible member 20 , the envelope 30 and the fastener 40 is simply introduced and brought into use position in an implantation tube 10, similarly to the first embodiment.
    In a third embodiment, the system 1 can be preassembled and ready for use, the compressible member 20 being wrapped in the casing 30 on which the fastener 40 is fixed and housed in the implantation tube 10. Here, the compressible member 20 is therefore in its compressed configuration.
    When the envelope 30 comprises a thread, the external surface of the compressible member 20 preferably has hemostatic properties prior to its implantation in the nasal cavity of a patient. For this, the compressible member 20 may for example be made of a material having such properties (for example, a compressible member 20 comprising oxidized regenerated cellulose). Alternatively, the compressible member 20 may be imbibed with a fluid having these hemostatic properties. In the latter case, once the compressible member 20 is introduced into the implantation tube 10, a catheter 50 comprising at least one injection orifice may be inserted into the recess of the compressible member 20 through the tube implantation 10 to inject the fluid into the compressible member 20. According to yet another variant, the compressible member 20 may be wrapped in a haze having hemostatic properties, such as a nonwoven web having an acidic pH so to give it hemostatic properties of the Surgicel® type. The haze having hemostatic properties is then placed between the compressible member 20 and the net 30.
    When the envelope 30 comprises a film, a haze having Surgicel®-type haemostatic properties is placed around the film 30 enveloping the compressible member 20 prior to their introduction into the implantation tube 10. In a variant, the haze exhibiting Hemostatic properties can be placed around the implantation tube, during the first step described below. The compressible member 20 may then comprise an inert foam.
    Then, during a first step, the implantation tube 10 is brought and positioned in the patient's nasal cavity, so that its distal end 14 is placed at the level of the epistaxis. If necessary, the operator can use any marks or graduations present on the implantation tube 10 to facilitate its positioning in the nasal cavity.
    In a second, optional step, a haemostatic agent (as a fluid) may be injected into the patient's nasal cavity. For this, when the compressible member 20 comprises a central recess 26, a catheter 50 having a distal injection orifice 56 may be introduced into the central passage 16 of the implantation tube 10 and into the central recess 26 of the compressible member 20 and positioned so that its injection port 56 is located opposite the nasal cavity. The hemostatic agent can then be injected. The catheter 50 can then be removed from the implantation tube 10.
    Alternatively, an analgesic product (local anesthetic) may also be injected with a syringe prior to the first step of introducing the implantation tube into the nasal cavity.
    According to another variant, the analgesic product may be injected into the compressible member 20, either before it is introduced into the implantation tube 10, or when the compressible member 20 is compressed in said tube 10 (the injection can then be performed using the catheter 50).
    During a third step, the compressible member 20 wrapped in the envelope 30 and optionally in the haze having haemostatic properties can be implanted in the nasal cavity. For this purpose, the compressible member 20 is brought into an area adjacent to the distal end 14 of the implantation tube 10, as can be seen in FIG. 1. Where appropriate, in this position, the compressible member 20 begins to to deploy at the flared end 15 of the implantation tube 10. It should be noted that, in one embodiment, the compressible member 20 can be placed from the start in this position, prior to the introduction step of the implantation tube 10.
    A mandrel 60 can then be implemented to maintain the compressible member 20 in position while, simultaneously, the implantation tube 10 is progressively extracted from the nasal cavity. For this the mandrel 60 is introduced into the implantation tube 10 by its proximal end 12 and pushed until it comes into contact with the compressible member 20. Note that during this manipulation, the distal end 14 of the laying instrument remains fixed relative to the nasal cavity, in order to guarantee the positioning of the compressible member 20. An operator can then continue to push on the mandrel 60 and simultaneously pull on the implantation tube 10, so as to extract the compressible member 20 from the distal end 14 and remove the implantation tube 10 from the nasal cavity. In this way, the compressible member 20 is progressively extracted from the implantation tube 10, the portion of the compressible member 20 projecting from the distal end 14 of the implantation tube 10 unfolding progressively in the nasal cavity.
    When the entirety of the compressible member 20 is extracted from the implantation tube 10, the compressible member 20, surrounded by the envelope 30 and, if appropriate, the haemostatic haze, is then accurately positioned in the nasal cavity and in expanded configuration. Indeed, the position of the compressible member 20 is determined by the position of the distal end 14 of the implantation tube 10 at the beginning of the third step, which can be precisely adjusted without risk of injuring the patient.
    Note that this progressive expansion further reduces the trauma suffered by the patient, the compressible member 20 being at no time moved.
    Furthermore, by adopting its expanded configuration, the compressible member 20, which is wrapped in the envelope 30 and optionally the haze having haemostatic properties, comes into contact with the walls of the nasal cavity.
    In an alternative embodiment, the mandrel 60 may comprise a central orifice to allow the operator to leave a catheter 50 in place in the compressible member 20, despite the removal of the implantation tube 10.
    The mandrel 60 and the implantation tube 10 can then be removed from the nasal cavity.
    Where appropriate, when the fastener 40 is removable, it can be detached from the envelope 30 so as not to hinder the patient.
    Alternatively, the clip 40 may be left in place.
    A hemostasis phenomenon can then take place, thanks to the hemostatic properties of the compressible member 20 or alternatively of the haemostatic veil which surrounds it. At the end of the hemostasis phenomenon, the compressible member 20 and the envelope 30 can then be removed.
    For this, during a fourth step, the implantation tube 10 can be reintroduced into the nasal cavity until it abuts against the proximal end 22 of the compressible member 20. If necessary, the attachment 40 is also attached to the central passage 16 of the implantation tube 10 projecting from its proximal end 12.
    During an optional fifth step, when the envelope 30 includes a thread, the compressible member 20 may be rewetted to soften it for removal. For example, a catheter 50 may be introduced into the central passage 16 of the implantation tube 10 and into the central recess 26 of the compressible member 20 to inject a fluid, such as physiological saline. If necessary, the operator can use any marks or graduations present on the catheter 50 to facilitate and improve its positioning in the compressible member 20.
    Alternatively, the rewetting step may be performed prior to the step of placing the implantation tube 10, for example using a syringe.
    When the envelope 30 comprises a film, the re-wetting of the compressible member 20 may be optional insofar as said compressible member 20 is not contaminated, thanks to the film which forms an interface with the nasal cavity of the patient. The compressible member thus preserves its compression properties.
    During a sixth step, the implantation tube 10 can be progressively advanced so as to receive the compressible member 20 and the envelope 30 in its distal end 14. Simultaneously, an operator pulls on the fastener 40, in order to to prevent the compressible member 20 moves during handling. In this way, the compressible member 20 is gradually reintroduced and compressed in the implantation tube 10 and comes off closer to the walls of the nasal cavity, thus greatly limiting the risk of secondary hemorrhage. The envelope 30, the implantation tube 10 and the fastener 40 thus make it possible to avoid sudden and complete detachment over the entire length of the compressible member 20, which would be extremely painful for the patient.
    Where appropriate, the use of a casing 30 comprising a thread having anticoagulant properties makes it possible to facilitate the separation of the compressible member 20 by interrupting the continuity of the surface of the compressible member 20 that can adhere to the walls of the the nasal cavity, without preventing hemostasis phenomena due to the small contact area between the thread 30 and the walls of the cavity.
    When the envelope comprises a film surrounded by a veil having hemostatic properties, only the film 30 and the compressible member 20 are reintroduced into the implantation tube 10, the veil remaining in place in the nasal cavity. The detachment of the film 30 and the compressible member 20 is then facilitated insofar as the separation is carried out beyond the hemostasis. The haemostatic haze can then be removed separately and in a non-traumatic manner, for example by means of a forceps, insofar as it is substantially altered by haemostasis.
    If necessary, the reintroduction of the compressible member 20 into the implantation tube 10 is also facilitated by the flared shape 15 of the distal end 14 of the implantation tube 10.
    When the entirety of the compressible member 20 (fitted into the envelope 30) is reinserted into the implantation tube 10, the compressible member 20 is then in a compressed configuration.
    During a seventh step, the implantation tube 10 can then be removed.
    Second embodiment: Compression from the inside of the compressible organ
    In this second embodiment, illustrated with reference to FIGS. 6 to 8, the compression device 110 is configured to suck air into the compressible member 120. For this purpose, the compression device 110 can in particular comprise an organ partial vacuum, capable for example of achieving a depression in the compressible member 120 of the order of 450 mbar. Furthermore, the envelope 130 is configured to seal the compressible member 120 in order to allow this partial vacuum.
    The compression device 110 may in particular comprise a syringe, for example a 50 ml syringe when the compressible member 120 has a length L of 10 cm for a diameter D of 2.8 to 2.9 cm.
    Alternatively, the compression device 110 could comprise a partial vacuum system 1 conventionally used in hospitals. The envelope 130, which is sealed here, must be able to withstand the pressure difference (with respect to the nasal cavity, which is at atmospheric pressure) created by the compression device 110 during the partial evacuation.
    For this, the envelope 130 may include a flexible film that can be extensible or non-extensible. The envelope 130 may for example comprise a polymeric film, such as a film of polyethylene, polyamide or polyurethane. The envelope 130 may have a thickness of between a few microns and a hundred microns.
    Unlike the systems of the prior art using an inflatable balloon whose pressurization is difficult to control, thus risking to traumatize the patient by applying excessive forces on the walls of his nasal cavity, the system of the invention thus proposes to apply depression to the organ 120 allowing the phenomenon of hemostasis during the introduction or extraction of the system and to apply pressure against the walls of the patient's nasal cavity by simply letting the organ take of itself a stable configuration close to its rest configuration.
    In addition, during the introduction of the compressible member 120 into a nasal cavity, the member 120 is in a compressed configuration and is therefore rigid in comparison with an inflatable balloon (which is, at the time of its introduction, deflated and therefore flexible). The manipulation of the system 1 is thus facilitated and more precise.
    As indicated above, the compressible member 120 may comprise a foam. The foam being enclosed in a hermetic envelope 130, it is not necessary that it has hemostatic properties. The foam can therefore be inert and be made of a material that does not have hemostatic properties.
    On the other hand, the envelope 130 can itself be enclosed in a haze having more haemostatic properties if it is desired to give the system 1 haemostatic properties, insofar as the haze is configured to come into contact with the walls. a nasal cavity. Such a web can in particular be made in an oxidized regenerated cellulose having hemostatic properties. The veil may then comprise a nonwoven web having an acid pH of the Surgicel® type. Note that this veil is however optional insofar as the compressive force applied by the compressible member 120 when it takes its expanded configuration allows itself to achieve a first hemostasis.
    If necessary, the envelope 130 may be lubricated to facilitate the introduction and removal of the system 1 into a nasal cavity of a patient. The compressible member 120 has a distal end 124, configured to be placed at the bottom of a nasal cavity of a patient, and a proximal end 122 opposite the distal end 124 at which the compression device is connected. 110.
    In order to facilitate the introduction of the compressible member 120 into a nasal cavity of a patient, the system 1 may further comprise a tube 140 or catheter, inserted in the compressible member 120 in order to stiffen it. For this purpose, a central recess 126 may be formed between the proximal end 122 and the distal end 124 of the compressible member 120. The tube 140 is then housed in this central recess 126. The assembly formed by the compressible member 120 and the tube 140 is then rigid, in particular when the compressible member 120 is in a compressed configuration, which greatly facilitates its introduction into a nasal cavity (particularly in comparison with the balloon systems , which are flexible).
    In one embodiment, the tube 140 is fixed in the compressible member 120. Where appropriate the tube 140 may be non-removable.
    Alternatively, the tube is hollow and is in fluid communication with the compression device 110. Through-holes 142 are further formed in the wall of the tube 140 to allow the compression device 110 to draw in air present. in the compressible member 120 via the tube 140 and its orifices 142. The through holes 142 preferably extend over a large part of the length L of the compressible member 120, between its proximal end 122 and its distal end 124, which makes it possible to homogenize the evacuation or the introduction of air when the compressible member 120 is brought into a compressed or expanded configuration. In this way, the compression and expansion of the compressible member 120 can be progressive and homogeneous over the entire surface of the compressible member 120, thereby reducing the trauma to the patient during its expansion (placement) and its compression (at the withdrawal).
    The tube 140 may have a length substantially equal to the length L of the compressible member 120 and protrude from said compressible member 120 at its proximal end 122.
    Alternatively, the tube 140 may have a longer length than that of the compressible member 120 and include a portion 144 configured to be attached to an area of the patient's body, when the compressible member 120 and the tube 140 are placed in a nasal cavity of said patient. It will be noted that the compressible member 120 is configured to remain in place in a nasal cavity of a patient for about 48 hours. It is therefore preferable that, during this period, the patient is not likely to further depress the compressible member 120 and can, as far as possible, be comfortably installed. The Applicant has therefore found that by extending the tube 140 so as to fix it on the cheek or the edge of the nose (for example) of the patient, the patient was less likely to move the compressible member 120 than when the tube 140 was just protruding from his nose.
    If desired, the extended portion 144 of the tube 140 projecting from the nose may be equipped with a fin 146 to facilitate attachment of this extended portion 144 to the patient's body.
    The system 1 may further comprise a latch 150 configured to allow the connection of the compression device 110 to the envelope 130 and thus allow the evacuation or the introduction of air into the compressible member 120. For this, the latch 150 may in particular comprise a first fixing member 152, connected to the casing 130 or the tube 140, and a second complementary fixing member 154, connected to the compression device 110.
    In the case where the system 1 comprises a tube 140, the first fixing member 152 may be fixed on the end of the tube 140 which projects from the compressible member 120. The envelope 130 is then hermetically sealed near the proximal end 122 of the compressible member 120, either on the tube 140 or on the first fastener 152, so as to form a sealed enclosure. For example, the envelope 130 may be sealed by gluing.
    When the tube 140 is lengthened so as to protrude from the patient's nose and to be attached to an area of its body, the first attachment member 152 may be attached to the end of the extended portion 144 of the tube 140, away from the patient. 120. This configuration also facilitates the manipulation of the system 1 by an operator, the latter being more free of its movements during the suction of air with the aid of the compression device 110. The envelope 130 is then hermetically sealed on the tube 140, at the outlet of the compressible member 120, so as to form a sealed enclosure (for example by gluing).
    The first and second fasteners 152, 154 may be conventional and include for example a Luer or Luer lock type system.
    The system 1 for the treatment of an epistaxis according to this second embodiment can then be implemented as follows.
    The implementation of this second embodiment will be detailed for a system 1 comprising a hemostatic haze and a tube 140, housed in a central recess 126 of the compressible member 120 and in fluid communication with the compression device 110. However, it will be understood that the use of the haemostatic veil is optional.
    In a first embodiment, the system 1 for the treatment of an epistaxis can be provided in kit form. The system 1 must then be mounted prior to its use. For this purpose, a compressible member 120 is firstly enveloped or introduced into an envelope 130. At this stage of the assembly, the compressible member 120 is in deployed configuration. The compressible member 120 may, for example, comprise an inert foam having a length L of between 8 and 12 cm, typically of the order of 10 to 11 cm, and having a diameter D of between 2.5 and 3.0 cm typically of the order of 2.8 to 2.9 cm.
    A tube 140 having through holes 142 is then introduced into the central recess 126 of the compressible member 120. The tube 140 may for example have an outer diameter of the order of 2 to 3 mm and between 3 and 10 through holes 142 distributed over the portion of its length which is housed in the compressible member 120. The tube 140 is further equipped, at its free end, with a fixing member 152. The envelope 130 may comprise a film polyurethane having a thickness of 50 microns. The envelope 130 is then sealed, for example on a portion of the tube 140 which projects from the compressible member 120, for example by gluing.
    A compression device 110, for example a syringe comprising a complementary fixing member 154, is then connected to the fixing member 152 of the tube 140. The compression device 110 can then reduce the pressure (relative to the ambient medium, which is at atmospheric pressure) in the assembly formed of the compressible member 120 enclosed in the casing 130 by sucking the contained air of said assembly until the compressible member 120 reaches its compressed configuration. In the case of a syringe, it is sufficient for example an operator to suck the air by moving the plunger of the syringe.
    Typically, for a compressible member 120 comprising the foam described above, the operator can reach a depression of the order of 450 mbar. Note that it is possible to achieve greater pressure in the compressible member: however, the foam would be less compressed, thus increasing the discomfort of the patient during the introduction of the wick.
    Then the assembly formed of the envelope 130, the compressible member 120 and the tube 140 may be wrapped in a haze having hemostatic properties.
    Alternatively, the assembly formed of the tube 140 pre-introduced into the compressible member 120 and hermetically sealed in the casing 130 may be preassembled and supplied as a kit to the operator, if necessary prepackaged in the web. It is therefore sufficient for the operator to connect the compression device 110, for example a syringe, to the tube 140 in order to reduce the pressure in the compressible member 120 and to bring the compressible member 120 into its compressed configuration.
    The syringe can be supplied with the kit which is then ready for use, or alternatively be separated from the kit (this variant being more easily conceivable when the connection is standardized, as can be a Luer or Luer lock connection).
    Then, during a first step, the assembly (formed of the compressible member 120 in compressed configuration, the tube 140, the casing 130 and the veil), which is fixed on the syringe, is brought and positioned in the nasal cavity of the patient so that the distal end 124 of the compressible member 120 is placed at the level of the epistaxis. This introduction is facilitated by the presence of the tube 140, which makes it possible to stiffen the assembly without increasing the bulk of the compressible member 120. The compressible member 120 (as well as the tube 140, the envelope 130 and the veil) is then accurately positioned in the nasal cavity. Indeed, the position of the compressible member 120 can be easily determined by the position of its distal end 124, which can be adjusted without risking injuring the patient insofar as the compressible member 120 is in a compressed configuration and thus has a small footprint.
    In a second step, the compressible member 120 may be deployed in the nasal cavity. For this purpose, the compressible member 120 is brought from its compressed configuration to its expanded configuration, that is to say its stable configuration and close to its rest position (the compressible member 120 being shape memory).
    In the case of a compression device 110 comprising a syringe, it suffices for example to disconnect the syringe, the compressible member 120 gradually recovering its shape by passive suction of air via the through holes 142 and the tube 140. Alternatively, the operator can reinject the air sucked previously in the compressible member 120 by pushing on the piston of the syringe. Preferably, the reinjection is performed gradually so as not to traumatize the patient.
    In all cases, the compressible member 120 unfolds gradually through the through orifices 142 formed along the tube 140, which reduces the trauma suffered by the patient, the compressible member 120 being at no time moved during its expansion. Furthermore, by adopting its expanded configuration, the compressible member 120, which is enclosed in the casing 130 and optionally the haze having haemostatic properties, comes into contact with the walls of the nasal cavity.
    The compression device 110 can then be removed. Where appropriate, when the tube 140 comprises an extended portion, optionally equipped with a fin 146, said extended portion may be attached to the skin of the patient.
    A phenomenon of hemostasis can then take place, thanks firstly to the compressive force applied by the compressible member 120 on the walls of the nasal cavity, and secondly to the hemostatic properties of the haemostatic veil which surrounds the patient. The casing 130 and the compressible member 120. At the end of the hemostasis phenomenon, the assembly formed by the compressible member 120, the casing 130, the tube 140 and the veil can then be removed.
    For this, during a third step, the compression device 110, for example a syringe, can be connected to the assembly. For example, the attachment member 154 of the syringe may be connected to the corresponding fastener 152 of the tube 140.
    During a fourth step, the pressure in the compressible member 120 is reduced so as to return the compressible member 120 in its compressed configuration. Typically, for a compressible member 120 comprising the foam described above, the operator can reach again the depression of the order of 450 mbar by moving the piston of the syringe so as to suck the fluids (including air) locked in the foam.
    The partial vacuum of the compressible member 120 is, here again, progressive. In addition, the air is sucked over the entire length of the compressible member 120 through the through orifices 142 formed in the tube 140. In this way, the compressible member 120 is gradually brought into its compressed configuration, slowly detaching itself. in a direction substantially perpendicular to the walls of the nasal cavity, as opposed to the tangential and total tearing that was generally achieved with conventional treatment systems.
    During a fifth step, when the compressible member 120 (enclosed in the envelope 130 and the web) has reached its compressed configuration, it can then be extracted from the nasal cavity.
    权利要求:
    Claims (13)
    [1" id="c-fr-0001]
    A system (1) for treating an epistaxis comprising: - a compressible shape memory member (20, 120) having a compressed configuration, wherein the compressible member (20, 120) is compressed and is configured to to be introduced into a nasal cavity of a patient, and an expanded configuration, in which the compressible member (20, 120) is deployed and is configured to contact walls of the patient's nasal cavity, - an envelope ( 30, 130) configured to envelop the compressible member (20, 120), and - a compressing device (10, 110) of the compressible member (20, 130) in the envelope (30, 130), said device compression device (10, 110) being configured to bring the compressible member (20) into its compressed or expanded configuration.
    [2" id="c-fr-0002]
    2. System (1) according to claim 1 wherein: the compression device comprises an implantation tube (10), configured to be introduced into the nasal cavity of a patient, said implantation tube (10) having a proximal end (12), a distal end (14) and a central through passage (16) extending between the proximal end (12) and the distal end (14), and said compressible member (20) being configured to be housed in the central passage (16) of the implantation tube (10) in a compressed configuration, and - a fastener (40) configured to be fixed to the envelope (30) and project from the proximal end (12). ) of the implantation tube (10) when the compressible member (20) is housed in the central passage (16), to facilitate the introduction of the compressible member (20) and the envelope (30) into the implantation tube (10) when the compressible member (20) is in configuration expanded.
    [3" id="c-fr-0003]
    3. System (1) according to claim 2, wherein the envelope (30) comprises a net or a film.
    [4" id="c-fr-0004]
    The system of claim 1, wherein: the envelope (130) is configured to hermetically seal the compressible member (120) to form a sealed enclosure, and - the compression device (110) is configured to decreasing a pressure in the assembly formed of the compressible member (120) enclosed in the casing (130) so as to bring the compressible member (120) into its compressed configuration.
    [5" id="c-fr-0005]
    The system of claim 4, wherein the envelope (130) comprises a flexible film.
    [6" id="c-fr-0006]
    6. System according to claim 5, wherein the casing (130) comprises a polyethylene film and / or a polyurethane film, said casing (130) being capable of having a thickness of between a few microns and a hundred microns.
    [7" id="c-fr-0007]
    7. System according to one of claims 4 to 6, wherein the compression device (110) comprises a syringe or a partial vacuum member.
    [8" id="c-fr-0008]
    8. System (1) according to one of claims 4 to 7, wherein the compressible member has a proximal end (122) near which is fixed the compression device (110) and an opposite distal end (124) at the proximal end (122), a central recess (126) being formed between the proximal end (122) and the distal end (124) of the compressible member (120) and the system (1) further comprising a tube (140) housed in the central recess (126).
    [9" id="c-fr-0009]
    The system (1) of claim 8, wherein the tube (140) is configured to be in fluid communication with the compression device (110) to reduce pressure in the compressible member (120), orifices therethroughs (142) being formed in the tube (140) between the proximal end (122) and the distal end (124) of the compressible member (120) to allow for progressive compression and expansion of the compressible member (120) along its entire length.
    [10" id="c-fr-0010]
    The system of one of claims 8 or 9, further comprising a latch (150) including a first fastener (152) attached to a proximal end (122) of the tube (140) and a second fastener (154) complementary fixed on the compression device (110).
    [11" id="c-fr-0011]
    11. System according to one of claims 8 to 10, wherein the tube (140) projects from the compressible member (120) and comprises a fin (146), configured to be fixed on an area of the body of a patient.
    [12" id="c-fr-0012]
    12. System according to one of claims 1 to 11, further comprising a haze having hemostatic properties covering the envelope (30, 130), said web may comprise a nonwoven web having an acidic pH in order to confer properties hemostats.
    [13" id="c-fr-0013]
    An assembly for the treatment of an epistaxis, comprising: a compressible member (120) having a compressed configuration, wherein the compressible member (20, 120) is compressed and configured to be inserted into a nasal cavity of a patient, and an expanded configuration, in which the compressible member (20, 120) is deployed and is configured to contact walls of the patient's nasal cavity, and - an envelope (130), said envelope (130) surrounding the compressible member (120) and being fixed on said compressible member (120) so as to form a sealed enclosure, said assembly being configured to be implemented in a system (1) for the treatment of an epistaxis according to the one of claims 1 to 12.
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    同族专利:
    公开号 | 公开日
    KR20180082430A|2018-07-18|
    WO2017050823A1|2017-03-30|
    FR3041237B1|2017-10-20|
    CA2999394A1|2017-03-30|
    US20180353197A1|2018-12-13|
    FR3041236A1|2017-03-24|
    JP6745336B2|2020-08-26|
    US10945747B2|2021-03-16|
    JP2018528012A|2018-09-27|
    EP3352684A1|2018-08-01|
    FR3041236B1|2017-10-20|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    US6517509B1|2000-02-02|2003-02-11|Ronald D. Shippert|Absorbent pack insertion into a human body cavity|
    WO2005053589A1|2003-12-03|2005-06-16|Microtech S.R.L.|Endoscopic surgery device for the insertion and recovery of a haemostatic plug at the surgical site|
    US20140276627A1|2013-03-15|2014-09-18|Acclarent, Inc.|Nasal fluid management device|
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    US7744583B2|2003-02-03|2010-06-29|Boston Scientific Scimed|Systems and methods of de-endothelialization|
    JP6483084B2|2013-03-15|2019-03-13|メタクティブ・メディカル・インコーポレイテッドＭｅｔａｃｔｉｖｅ Ｍｅｄｉｃａｌ， Ｉｎｃ．|Expandable body device and method of use|EP3668464A4|2017-08-15|2021-08-18|Binyarco LLC|Method and device for packing a body cavity and delivering a medicament to a subject|
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    法律状态:
    2017-01-12| PLFP| Fee payment|Year of fee payment: 2 |
    2017-03-24| PLSC| Publication of the preliminary search report|Effective date: 20170324 |
    2018-01-12| PLFP| Fee payment|Year of fee payment: 3 |
    2020-01-10| PLFP| Fee payment|Year of fee payment: 5 |
    2021-01-13| PLFP| Fee payment|Year of fee payment: 6 |
    2021-12-10| PLFP| Fee payment|Year of fee payment: 7 |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1558872A|FR3041236B1|2015-09-21|2015-09-21|SYSTEM FOR TREATING EPISTAXIS|JP2018515000A| JP6745336B2|2015-09-21|2016-09-21|A system to treat epistaxis|
    US15/761,645| US10945747B2|2015-09-21|2016-09-21|System for treating an epistaxis|
    PCT/EP2016/072419| WO2017050823A1|2015-09-21|2016-09-21|System for treating an epistaxis|
    CA2999394A| CA2999394A1|2015-09-21|2016-09-21|System for treating an epistaxis|
    KR1020187011161A| KR20180082430A|2015-09-21|2016-09-21|System for treating non-bleeding|
    EP16775543.8A| EP3352684A1|2015-09-21|2016-09-21|System for treating an epistaxis|
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