JP6076847B2 - Laser therapy device - Google Patents

Description

  The present invention relates to a laser treatment device that can be incorporated into an endoscope, and more particularly to a laser treatment device using an optical fiber having a rectangular cross section that enables effective hyperthermia by uniformly irradiating a wide area.

  An endoscope is a medical device mainly intended for observation inside the human body. An optical system is built in the barrel of the endoscope, and the distal end of the barrel is inserted into the body to display an image inside the human body on the monitor. In recent years, a laser endoscope in which a laser treatment device is incorporated in this endoscope has attracted attention as a new cancer treatment method. This laser endoscope is usually used in such a manner that cancer is roughly removed by conventional endoscopic surgery, and the remaining cancer cells are completely killed by irradiating the removed marks with laser light.

  In addition, when the tumor is relatively small and does not deeply infiltrate the tissue, an attempt is made to kill cancer cells by hyperthermia using a laser endoscope without performing endoscopic surgery. This hyperthermia (cancer hyperthermia) is a treatment method in which the tumor is heated at 42 ° C. or higher for 30 to 60 minutes. Hyperthermia is expected not only to kill cancer cells but also to increase the immune function of normal cells by heating and to enhance the effects of radiation and chemotherapy.

  The endoscope uses a rod-like rigid mirror with a hard barrel and a flexible mirror made of a flexible tube depending on the method and purpose of the operation. The laser treatment device according to the present invention is mainly incorporated into a rigid endoscope, but can be incorporated into a flexible endoscope by downsizing.

  There are two types of endoscopes: an optical type in which a plurality of lenses are housed in a lens barrel, and an electronic type in which a camera unit using a CCD image sensor is provided at the tip of the lens barrel. An illumination part (external light introduction type or LED light emission type) capable of irradiating strong light is provided at the end of the lens barrel. There is also an endoscope including a surgical instrument. For example, Patent Document 1 (US Pat. No. 4,836,189) is known as a hysteroscope including a laser knife.

U.S. Pat. No. 4,836,189

  The thickness (diameter) of an endoscope varies from a large one to a small one depending on the type, but in general, in order to reduce the burden on the patient, the diameter is decreasing. Conventional laser endoscopes generally use a bare fiber (bare core optical fiber) to guide laser light.

  This bare fiber uses an optical fiber having a circular cross section, and in the case of non-contact irradiation, the beam profile forms a mountain shape that is highest at the center of the cross section and lower toward the periphery. For this reason, the area that can be used for laser treatment is limited to the vicinity of the center of the beam profile, and there is little available area for the fiber cross section. Therefore, it took a long time to irradiate a certain area, and the patient was burdened by that much, or a sufficient therapeutic effect could not be obtained.

  In order to irradiate laser light of uniform intensity over a wide range, it is necessary to increase the diameter of the optical fiber. However, if it does so, the diameter of the whole laser endoscope will also become large, the site | part which can use an endoscope has been limited, the big burden was imposed on the patient, or the operativity worsened.

  SUMMARY OF THE INVENTION An object of the present invention is to provide a laser treatment device for a laser endoscope that can irradiate a laser beam with uniform intensity over a wide range and can relatively reduce the diameter of the endoscope.

  In order to solve the above problems, the present invention provides an optical fiber having a rectangular cross-section for guiding a therapeutic laser beam, a cylindrical part that serves as a lens barrel of an endoscope that connects the distal ends of the optical fiber, and the optical fiber disposed in the cylindrical part. And formed between a guide tube having a rectangular cross section for guiding laser light emitted from the tip of the optical fiber to the tip of the tube, and between the sides of the guide tube and the inner peripheral surface of the tube. A laser treatment device comprising imaging means and illumination means arranged in a gap between the bottoms of the ship.

  In the laser treatment device of the present invention, since the optical fiber has a rectangular cross section, it is possible to irradiate a so-called top-hat type uniform intensity laser beam over a wide range. In addition, the image pickup means and the illumination means can be arranged without waste using the gap at the bottom of the ship formed around the guide tube having a rectangular section for guiding the laser light. For this reason, it is possible to reduce the diameter of the cylindrical part that becomes a lens barrel when incorporated in an endoscope, thereby reducing the burden on the patient and improving operability, and an effective laser by uniform irradiation over a wide area. Treatment (hyperthermia) becomes possible.

1 is an overall schematic diagram of an endoscopic laser system for cervical cancer treatment using a laser treatment device according to an embodiment of the present invention. It is sectional drawing of the cylinder part front-end | tip part of a laser treatment apparatus. It is an internal perspective view of the cylinder part front-end | tip part of a laser treatment apparatus. The temperature sensor arrange | positioned at the cylinder part front-end | tip part of a laser treatment apparatus is shown, (A) is a front end surface, (B) is a cross section, (C) shows the CC arrow directional cross section of (B). FIG. It is a block diagram of an endoscope laser system. (A) (b) is a cylinder section front end sectional view of a laser treatment device. It is a side view of the front-end | tip part of the cylinder part of a laser treatment apparatus, Comprising: (a) is a side view of the type which does not protrude a laser irradiation part, (b) is a side view of the type which protruded the laser irradiation part. It is a figure which shows the usage example as a cervical cancer laser endoscope. It is a figure which shows the beam profile of a rectangular laser beam. It is the image figure which compared the beam profile of the laser beam with a rectangular fiber and a bare fiber.

  Hereinafter, a laser treatment device according to an embodiment of the present invention will be described with reference to the drawings. FIG. 1 is an overall schematic view of an endoscopic laser system for treating cervical cancer using a laser treatment device 1. The endoscope used in the system is a rigid endoscope. This rigid endoscope can be used for a laparoscope, a thoracoscope, a cystoscope and the like in addition to a cervical cancer endoscope.

  The laser treatment device 1 has a cylindrical portion 2 that is a lens barrel constituted by a cylindrical body 2a having a circular cross section. A handle 3 is attached to the proximal end portion of the cylindrical portion 2. A cable 4 containing an optical fiber 10 and an electric wire (not shown) is connected to the proximal end of the handle 3. With the cable 4, the laser treatment device 1 is connected to the laser oscillator 5 and the controller 6. An image is output to the liquid crystal monitor 7 by the controller 6.

  The cylindrical body 2a of the cylindrical portion 2 is formed in a cylindrical shape having a diameter of, for example, about 30 mm, and the tip of the optical fiber 10 is connected to the optical system 30 at the center position inside as shown in FIG. The optical fiber 10 includes a core 10 a having a rectangular (square) cross section and a clad 10 b covering the outer periphery thereof, and an end surface of the core 10 a is connected to the optical system 30. The right radiation side of the optical system 30 is connected to a guide cylinder 2b having a rectangular (square) cross section disposed coaxially in the cylinder 2a, and the guide cylinder 2b extends to the tip of the cylinder 2a. . And the front-end | tip part of the cylinder 2a is made into the transparent laser irradiation part 20. As shown in FIG.

  The four corners of the guide tube 2b are in contact with the inner peripheral surface of the cylindrical body 2a having a circular cross section as shown in FIG. 2B. Therefore, four bottom-shaped gaps (first gap C1 to fourth gap C4) are formed between the straight sides of the guide cylinder 2b and the inner peripheral surface of the cylinder 2a.

  In the embodiment of the present invention, the four gaps C1 to C4 of the ship bottom shape are effectively used as an arrangement space for the imaging means and the illumination means. That is, a camera unit 11 using a CCD image sensor as an imaging unit is disposed in the first gap C1, and three white LED units 12 as illumination units are disposed in the second gap C2.

  In addition, two white LED portions 12 as illumination means are disposed in a third gap C3 facing the camera portion 11 with the optical fiber 10 interposed therebetween. And in the 4th clearance gap C4, one ultraviolet LED part 13 as an illumination means is arrange | positioned. The ultraviolet LED unit 13 is used to distinguish between normal tissue and diseased tissue based on the difference in the intensity of autofluorescence emitted from the tissue by irradiating the tissue with ultraviolet light. Of course, the number of LEDs can be appropriately increased or decreased for both white and ultraviolet in accordance with the size of the gaps C2 to C4 and the type of LED.

  Note that a cleaning nozzle unit may be disposed adjacent to the camera unit 11 as is known in conventional endoscopes. By spraying physiological saline into the camera unit 11 from the washing nozzle unit, blood or the like attached to the camera unit 11 can be removed.

  A temperature sensor unit 25 is disposed on the laser irradiation unit 20 at the tip of the cylindrical body 2a as shown in FIG. The temperature sensor unit 25 is composed of a coated thermocouple with the temperature measuring point 25a exposed. In the figure, 25b is a thermocouple element, 25c is a thermocouple element covering insulating material, and 25d is a skin insulating material.

  The temperature sensor unit 25 is accommodated in a radial groove 20 a formed from the central part of the laser irradiation unit 20 toward the peripheral part. The coated thermocouple of the temperature sensor unit 25 can be an extremely thin one, and even those having a major axis of 0.5 mm or less can be easily obtained from a plurality of manufacturers. The coated thermocouple is preferably gold-plated over the entire area so as not to be affected by the laser beam L.

  A temperature measuring point 25 a is provided at the tip of the temperature sensor unit 25, and the temperature measuring point 25 a is located at the center of the laser irradiation unit 20. The temperature sensor unit 25 does not form the radial groove 20a in the laser irradiation unit 20, but is exposed to the laser irradiation unit 20 and attached with an adhesive or the like, or only the temperature measuring point 25a is exposed to the laser irradiation unit 20, The remaining portion may be embedded in the laser irradiation unit 20.

  In hyperthermia, a depth of about 5 to 10 mm from the tissue surface is heated to 42 ° C. or higher. Therefore, the wavelength and intensity of the laser light are adjusted based on the output of the temperature sensor unit 25 so that the temperature can be reliably obtained.

  FIG. 4 is a block diagram of an endoscopic laser system for treating cervical cancer. The small camera unit 11, the white LED unit 12 and the ultraviolet LED unit 13 are controlled by the controller 6. The controller 6 includes a monitor control unit 6a, a light control unit 6b, a control module 6c, and a power supply unit 6d. The output of the temperature sensor unit 25 is fed back to the laser oscillator 5, thereby adjusting the wavelength and intensity of the laser light.

  The cross-sectional shapes of the optical fiber and the guide cylinder described above are not necessarily square as shown in FIG. 5A, and may be rectangular as shown in FIG. In this case, since a relatively large first gap C1 and second gap C2 are formed above and below the guide tube 2b, for example, the camera unit 11 and the white LED unit 12 are disposed in the first gap C1, and the first The ultraviolet LED portion 13 is disposed in the gap C2 between the two.

  The laser irradiation unit 20 at the distal end of the racer treatment device 1 may be disposed on the same plane as the distal end surface of the cylindrical portion 2 as shown in FIG. 6 (a), or the cylindrical portion 2 as shown in FIG. 6 (b). You may arrange | position by making it protrude a little from the front end surface. As shown in FIG. 6B, by arranging the laser irradiation unit 20 so as to protrude, the laser irradiation unit 20 can be easily brought into close contact with the tumor, and efficient irradiation of laser light is facilitated.

  FIG. 7 is a usage example of a cervical cancer endoscope incorporating the laser treatment device 1 according to the embodiment of the present invention. The laser light emitted from the laser irradiation unit 20 is irradiated in a rectangular shape over a wide area and has a top hat type uniform intensity laser profile as will be described later, so that the tumor surface can be heated uniformly over a wide area. it can. Therefore, for example, in cervical cancer and the like, a method of using the entire tumor within the irradiation range and killing all cancer cells by one irradiation is possible.

  Even if the cross-sectional shape of the optical fiber or the guide tube is square or rectangular, a so-called top-hat type uniform beam profile as shown in FIG. 8A can be obtained. In the case of normal hyperthermia, the output of the laser beam can be set to about 5 W, for example. However, depending on the content of treatment, the output may be as low as several hundred mW.

  FIG. 8B is an image diagram comparing a rectangular fiber and a bare fiber (bare core optical fiber). In this way, the rectangular fiber can irradiate laser light having a constant intensity over a wider range than the bare fiber. Therefore, the therapeutic effect of hyperthermia can be improved.

  Although one embodiment of the present invention has been described above, the present invention is not limited to the above embodiment, and various modifications can be made. For example, the illuminating unit has exemplified the white LED unit 12 and the ultraviolet LED unit 13, but is not limited to such LEDs, and other illuminating units may be an external light introducing type in which, for example, an external laser beam for illumination is introduced by an optical fiber.

1: Laser therapy device 2: Tube portion 3: Handle 4: Cable 5: Laser oscillator 6: Controller 7: Liquid crystal monitor 10: Optical fiber 11: Camera portion 12: White LED portion 13: Ultraviolet LED portion 20: Laser irradiation portion 25 : Temperature sensor unit 30: Optical system C1-C4: Clearance at the bottom of the ship

Claims (5)

  An optical fiber having a rectangular cross-section for guiding a therapeutic laser beam, a cylindrical portion serving as a lens barrel of an endoscope connecting the distal end of the optical fiber, and a laser beam disposed in the cylindrical portion and emitted from the distal end of the optical fiber A guide tube having a rectangular cross section for guiding the tube to the tip of the tube portion, and an image pickup disposed in a bottom-shaped gap formed between the sides of the guide tube and the inner peripheral surface of the tube portion A laser treatment device comprising: means and illumination means.   2. The laser treatment according to claim 1, wherein the cross section of the optical fiber and the guide cylinder is square, and the imaging means and the illumination means are dispersedly arranged in a bottom-shaped gap formed at four locations around the guide cylinder. vessel.   2. The laser according to claim 1, wherein the optical fiber and the guide cylinder are rectangular in cross section, and the imaging means and the illumination means are dispersedly arranged in a bottom-shaped gap formed at two locations around the guide cylinder. Treatment device.   The laser treatment device according to any one of claims 1 to 3, wherein the illumination unit includes a white LED portion and an ultraviolet LED portion.   The laser treatment device according to any one of claims 1 to 4, wherein the imaging means comprises a camera unit using a CCD image sensor.