CN106039551A

CN106039551A - Catheter apparatus and radiation brachytherapy system

Info

Publication number: CN106039551A
Application number: CN201610431937.3A
Authority: CN
Inventors: 杨凯琳; 王暄棉; 张维哲
Original assignee: Beck Biological Medicine Ltd By Share Ltd
Current assignee: Beck Biological Medicine Ltd By Share Ltd
Priority date: 2016-06-17
Filing date: 2016-06-17
Publication date: 2016-10-26

Abstract

The invention provides a catheter apparatus, which comprises a tubular structure, a plurality of fluid flow pipe structures, a plurality of node units and an outer layer element, wherein each fluid flow pipe structure is provided with a near end direction and a far end direction and is arranged in a first axial direction of the tubular structure; the plurality of the node units are distributed in the axial direction of the tubular structure, and an interval is formed between every two adjacent node units; the plurality of the node units are covered by the outer layer element, so that a space is defined by the interval which is formed between the every two adjacent node units. By virtue of the catheter apparatus, the entire section of pervasive cancer can be radiated in one brachytherapy, and repeated placement of catheters can be avoided; and meanwhile, the catheter apparatus, which is free from the addition of an airbag, can be smoothly implanted in the narrow lumen of a patient. The invention also provides a radiation brachytherapy system adopting the catheter apparatus.

Description

A kind of pipe guide and proximity radiotherapy system

Technical field

The present invention relates to a kind of for the radiocurable pipe guide of proximity, particularly relating to have can the proximity of breathing element Radiotherapy pipe guide and proximity radiotherapy system.

Background technology

Radiotherapy can divide and does two big classes, is External radiotherapy and proximity radiotherapy (brachytherapy), tumor respectively Brachytherapy be to utilize conduit to enter body cavity or organ, by conduit around tumor tissues, lotus formula therapeutic instrument after recycling, Source of penetrating delivers into conduit, makes the lonizing radiation irradiation at short distance tumor region that source of penetrating is released, and allows its light wave or high-velocity particles The high energy radiation that kenel transmits, destroys tumor cell, a kind of technology of suppression growth of tumour cell.Brachytherapy is the suitableeest Share in being grown in endoceliac tumor, such as esophageal carcinoma, cervical cancer, carcinoma of endometrium, nasopharyngeal carcinoma, pulmonary carcinoma, rectal cancer, and Other tool tube chambers can be with the tumor of deployment catheter.It addition, brachytherapy also can be by the mode of tissue contact pin for non-tube chamber Tumor, such as prostate parcinoma, breast carcinoma, malignant sarcomas, cerebroma etc..

When carrying out External radiotherapy or proximity radiotherapy, the normal structure around tumor all can be made because of according to being put Ray and have side effects.As a example by skin, at the position often rubbed against, as inferior in oxter, hip, appearance after lonizing radiation irradiate Easily inflammation broken skin.Abdominal part accepts radiation cure the most often diarrhoea side effect.Incidence radiation cure is it is possible that saliva Become viscous, saliva minimizing, sense of taste change, oral mucosa redness, xerostomia, swallow pain difficulty, even appetite forfeiture etc. situation. Thoracic cavity radiation cure may produce radiation pneumonia, esophagus inflammation etc., even esophagus acute hemorrhage.Therefore, radiotherapy is Preferably situation is the dosage that be enough to make tumor cell lethal, protects normal structure simultaneously.

The side effect of radiation cure occurs, relevant with the dosage accepting lonizing radiation irradiated site and irradiation.Control with proximity As a example by treatment, it is nearer that normal structure distance penetrates source, then normal structure institute absorbed dose are the highest, and side effect is the biggest.Because of radiation source strength Degree degree can be inversely proportional to square distance and successively decrease.Therefore the optimal dose of brachytherapy is can kill tumor cell, but do not cause The dosage of the injury of normal structure.Such as Fig. 1 (Hitoshi Ikushima, Radiation therapy:state of the art and the future,The Journal of Medical Investigation Vol.57February 2010) Shown in.The most in the way of improving the pliable degree of dosage (dose conformity) and the uniformity (dose homogeneity) Improve tumor cure dose, and reduce dosage that normal structure lonizing radiation irradiate and scope (makes normal tissue toxicity in Fig. 1 bent The right displacement of alignment), to promote cure rate and to reduce normal tissue toxicity.And due to each sufferer body cavity/organ and tumor size The most different, optimal therapeutic dose can be provided according to its normal structure of each sufferer, tumor and radioactive source situation, be clinical The difficulty that upper individualized medical treatment is maximum.Natural internal displacement (internal can be had along with breathing plus intracorporeal organ Movement), such as when air-breathing, diaphragm declines thoracic cavity and swells, and all are positioned at intrathoracic internal organs and all can move because of breathing Dynamic, cause radiotherapy inaccuracy, therefore need the deviation of displacement to be also contemplated for into, such as Fig. 2 (Hitoshi during treatment Ikushima,Radiation therapy:state of the art and the future,The Journal of Medical Investigation Vol.57February 2010) in tumor size GTV (Gross tumor volume) i.e. Tumor size position in image；Range of scatter CTV (Clinical target volume) is the diffusion model that tumor is possible Enclose；Movement deviation scope ITV (Internal target volume) then comprises the deviation range of internal displacement；Treatment border model Enclosing PTV (Planning target volume) is the bounds in treatment plan.Due to extracorporeal six field radiation or other are in outside Fixing brachytherapy mode, all accurately cannot be relatively fixed radioactive source with tumor, extra normal structure therefore can be allowed to be subject to To radiological dose (ITV, PTV scope), on the other hand, brachytherapy needs to carry out the course for the treatment of for several times, needs to position with really accurately Protect tumor each course for the treatment of and all receive consistent therapeutic dose, the concordance of maintaining treatment and repeatability.

So that dose radiation is more uniform in the distribution of affected part, and side effect, pipe guide is avoided to develop Overstriking caliber, makes source of penetrating be placed in the mode in the middle of conduit.After overstriking conduit is inserted body cavity so that perienchyma with penetrate source away from From identical.The Bonvoisin-Gerard Esophageal Applicator product of such as Elekta, this conduit is i.e. with whole The mode of section conduit overstriking struts body cavity in order to penetrating source.Though but whole section of overstriking is penetrated source and put middle function, but the shape of tumor Shape differs, varying in size of the tumor growth of different sections, whole section of conduit with same amplitude overstriking, because of penetrate source dosage and away from Being inversely proportional to from square, when a part of tumor growth is only limitted to the shallow place of table, the normal tissue site being irradiated to is the most more, causes Side effect.And in the bigger and narrow serious place of tumor, strut with same size, it is likely to result in the food that pipe friction is narrow Road wall tumor and cause hemorrhage, make patient not feel well.And because esophagus is the smooth organ can wriggled again, if using whole section of conduit Overstriking and without rise and fall tubing, easily cause conduit slide, fixed effect is the best.

Another conduit Standard Nasopharyngeal Applicator Set of Elekta, then be to be inserted by conduit Patient's body cavity, then strut body cavity with airbag aeration, as shown in Fig. 3 (a), but the air bag additional at this, before unaerated in The state of existing shrinkage, as shown in Fig. 3 (b), can be likely to result in sufferer sense of discomfort, very with body lumen wall friction when entering body cavity Damage to causing cavity wall.

Again as a example by conduit disclosed in U.S. Patent Bulletin US6575932B1, it has 2 air bags, can inflate respectively, So as A/C in body cavity；Determine the spacing of air bag again by the pipe in the middle of flexible two air bags, intermediate tube is provided with Opening can be administered.But as this conduit is used for brachytherapy, intermediate tube passes through for penetrating source, if 2 air bag intermediate distances The shortest, the source of penetrating is suitable only for resting on this bit of position to guarantee that neutralization dose uniformity is put in source of penetrating.Swell when there being diffusivity in tube chamber When onch-tumor length is more than 3 centimeters, needs to repeat deployment catheter and radioactive source, easily cause the injured of cavity, and repeatedly grasp Take considerable time the spirit with sufferer, add that fractional dose linking is extremely difficult, occur simultaneously in neighbouring two ranges of exposures that are connected Place easily has dosage overlapping and causes dosage to exceed standard, and is likely to result in the damage that cannot repair, increases unnecessary risk.If 2 Air bag intermediate distance elongates, then be difficult to the position of fixing whole section of tumor, and patient is easily because breathing or mobile so that conduit is sliding Dynamic, change and penetrate source position, make tumor cell cannot obtain enough therapeutic doses, and normal structure accepted multiple dose and causes damage Wound.

The design of the conduit of China Patent Publication No. CN202387089U, i.e. attempts to reach length of tumor more than 3 centimeters Time fix tumor.This conduit has catheter body, developing ring, at least two sacculus, balloon cavity, sacculus fills passage, sacculus is noted Entrance, seal wire (guide wire) passage, silk guide passage inlet.It is identical with the quantity of sacculus that sacculus inlet, sacculus fill passage. Balloon diameter is identical, is shaped as elongated cylindrical, first fills end sacculus, fill adjacent sacculus the most successively during treatment； Thus on the basis of end balloon expandable, be changed without foley's tube and can directly extend sacculus entire length, reach fixing swollen Tumor when tumor length is more than 3 centimeters.But because of the auxiliary treatment of needs guide wire, add operational trouble.And sacculus For additional elongated cylindrical air bag, during inflation, once aeration quantity is not enough, or sticking together place when balloon engages conduit offsets, and all may be used Can make the balloon can not even inflation so that the source of penetrating is unable to maintain that the center at conduit, will reduce the repeatability for the treatment of plan.

In difficulty operationally, it is easiest to make sufferer uncomfortable with the treatment of esophageal carcinoma again.Esophageal carcinoma brachytherapy because Import the highest radiation therapy dosage, be likely to result in the side effect such as acute hemorrhage, therefore must be very in clinical use Note.The most use nasogastric tube are treated, but because its diameter is relatively thin, fixed effect is poor and cannot make to penetrate to come from During tube chamber is put, nasogastric tube can be attached in esophageal wall at random, makes source of penetrating and normal oesophageal wall hypotelorism cause dosage too high, Produce radiation focus, easily cause serious side effects, affect doctor and use wish.And in order to avoid the generation of serious side effects, U.S. American Brachytherapy Society advises: the pipe diameter of brachytherapy should be at least at 10mm. Elekta Yu Varian company also develops the treatment tubing of this kind of overstriking caliber, but the tubing of overstriking needs to put into from oral cavity, Cannot put into from nasal cavity, and may press into tumor.And clinically need coordinate Gastroenterology doctor operation, endoscope assist under with Guide wire is guided by oral area and inserts body cavity.Discharging of guide wire adds working procedure, and is put into by oral cavity, easily causes vomiting Reflecting or swallow reaction and change catheter position, more causing the sense of discomfort of patient, therefore must bestow tranquilizer or anesthesia, sufferer is also Must lie on one's side, increase operational inconvenience and risk.But, after obtaining tumor imaging data, doctor determine sufferer treatment meter Draw (determine She Yuan stop place and the time of staying), then sufferer is moved on to sick bed prepare to accept brachytherapy, if now sufferer The flexibility lain on one's side has change, and the appropriate of the treatment plan of doctor will reduce, and makes treatment inaccuracy.

The conduit of many air bags also has a kind of conduit that U.S. Patent Bulletin US6527692B1 provides, and this conduit is used for blood Brachytherapy in pipe, has the air bag of more than two equally and can inflate/topping up respectively, and filling purpose respectively is fixing leading While pipe position, because other untapped air bags can scale immediately, allow blood can pass through blood vessel at untreated section And do not block.But its bladder shape is hollow ring column (donut shape) or helical form (spiral shape), additional On conduit, the gas/liquid needing filling a certain amount of can maintain the shape of tool support function, therefore in small size filling In the case of, easily causing filling uneven and offset, the source conduit of penetrating is unable to maintain that center.But if maintaining hollow ring column Body or spiral helicine bladder shape, and when making tolerance the biggest, if body cavity is narrow because of tumor undue growth, sufferer may be made not Suitable, even result in tumor Rupture haemorrhag.And clinically when placing conduit, even if the air bag applied to conduit is unexpanded shape State, when inserting the narrow cavity of sufferer, also can affect the smooth degree inserted because of the existence of additional air bag, is entering body cavity Time can and body lumen wall friction and cause sufferer sense of discomfort even cavity wall to damage.

A kind of conduit that U.S. Patent Bulletin number 5910101 provides, has the air bag of more than two equally and can fill respectively Gas/topping up, even the air bag purpose of more than two is at vascular bending, it is also possible to give brachytherapy, but proximity is controlled Treatment the most important thing is, dosage and the square distance in source of penetrating are inversely proportional to, though this conduit gives at knee because of many airbag design Bestowing the possibility for the treatment of, when failing to solve inflation equally, once aeration quantity is not enough, or sticks together place when balloon engages conduit and offset, May make the balloon can not even inflation so that the source of penetrating is unable to maintain that the RC problem at conduit.It is equally applicable to blood vessel near Connecing treatment, a kind of conduit for brachytherapy that also U.S. Patent Bulletin US7384411B1 provides, this conduit is dimension Hold that blood is smooth and easy to be passed through, conduit employs the design of channel design (communication structure), channel design Be provided with passage so that conduit insert internal after, the blood of sufferer etc. can smooth and easy pass through, it is to avoid causes blood channel to block, also Can be applicable to the treatment of respiratory tract, pass through for the gas needed for patient.But during this conduit air bag to be used, be added to lead to Road structure peripheral, adds the volume of conduit, when entering body cavity, it is also possible to cause sufferer sense of discomfort very with body lumen wall friction Damage to cavity wall.

At present conduit also exists disadvantages mentioned above, therefore, how to design one and can reduce normal structure and irradiated by lonizing radiation Scope, it is to avoid side effect, can meet in multiple tumors, or in the case of diffusivity tumor, it is not necessary to need repeatedly to grasp simultaneously Make, take considerable time the energy with sufferer, and need not the auxiliary of guide wire, it is to avoid multi-pass operation, the most not with additional gas Capsule or overstriking caliber reach above-mentioned purpose, lead avoiding affecting the one of smooth degree when inserting the narrow cavity of sufferer or discomfort Pipe, desires most ardently the problem of solution the most at present.

Summary of the invention

This case provides a kind of pipe guide, comprising: a tubular structure；A plurality of fluid flow tubes structures, respectively have one near Extreme direction and a distal direction, and along one first direction of principal axis setting of described tubular structure；A plurality of node units, along institute State the described first direction of principal axis spread configuration of tubular structure, wherein between the adjacent described node unit of each two, form section between； And an outer layer element, described outer layer element is coated with a plurality of described node units, makes to be formed between two adjacent node unit Described between section form a space.

According to above-mentioned conception, wherein having more a plurality of described outer layer element, a plurality of described outer layer elements are each distinguished Be coated with by two adjacent described node units is formed one described between section, make between two adjacent described node units formation Described section forms a space.

According to above-mentioned conception, the quantity of wherein said fluid flow tubes structure is more than four；The quantity of described node unit It it is more than five；And the quantity of described outer layer element is more than four.

According to above-mentioned conception, wherein said a plurality of fluid flow tubes structures have a control unit on described proximal direction Part, the described outer layer element that described control element links for making the described distal direction of described fluid flow tubes structure, in described Between the most independent breathing of fragment position.

According to above-mentioned conception, wherein said a plurality of fluid flow tubes structures have a plurality of control on described proximal direction Element, a plurality of described control elements are each independently disposed on the described proximal direction of described a plurality of fluid flow tubes structure； The described outer layer element that described control element links for making the described distal direction of described fluid flow tubes structure, between described The most independent breathing of fragment position.

According to above-mentioned conception, wherein said node unit is a hollow cylinder structure, and wherein vacancy is for described tubular structure Along described first direction of principal axis by described node unit；And set along described first direction of principal axis on the post jamb of described hollow cylinder Having a passage, described passage passes through described node unit for described fluid flow tubes structure along described first direction of principal axis.

According to above-mentioned conception, the outside of the described hollow cylinder structure of wherein said node unit also has a then ring Portion；Described outer layer element links with described node unit through described then ring portion, makes between two adjacent described node units Formed described between Duan Weiyi confined space.

According to above-mentioned conception, the most also there is an outer ring structure, make described outer layer element be fastened on described in then ring portion.

According to above-mentioned conception, wherein said node unit is a hollow cylinder structure, and wherein vacancy is for described tubular structure Along described first direction of principal axis by described node unit；And set along described first direction of principal axis on the post jamb of described hollow cylinder Having a passage, described passage passes through described node unit for described fluid flow tubes structure along described first direction of principal axis；Wherein institute The outside of the described hollow cylinder structure stating node unit also has one and highlights ring portion；A plurality of described outer layer elements are along described First direction of principal axis is connected in the described prominent ring portion of two adjacent described node units, makes between two adjacent described node units Formed described between section form a space.

According to above-mentioned conception, the length of the described fluid flow tubes structure of at least a part of which two is different, so that a plurality of described stream Body tube flowing structure each communicate with different described between section.

According to above-mentioned conception, the most a plurality of described fluid flow tubes structures also each have an opening, wherein said open Mouthful position be each arranged at different described between fragment position so that different described fluid flow tubes structures is opened described in respective Mouth fluid is delivered to different described between section.

The present invention separately provides a kind of proximity radiotherapy system, including: lotus formula therapeutic instrument after；A kind of such as above-mentioned conception institute The pipe guide stated, is connected on described rear lotus formula therapeutic instrument；And a brachytherapy sources, described rear lotus formula therapeutic instrument release institute State brachytherapy sources in the described tubular structure of described pipe guide.

According to above-mentioned conception, wherein further having a tumor imaging instrument, described rear lotus formula therapeutic instrument is according to described Tumor imaging instrument determine release described brachytherapy sources to described tubular structure described between fragment position.

According to above-mentioned conception, wherein, described tumor imaging instrument includes but not limited to X-ray imaging, fluorescent photoscope, computer Tomoscan, positron emission tomography, single photon emission tomographic imaging, NMR (Nuclear Magnetic Resonance)-imaging.

Accompanying drawing explanation

Fig. 1 is radiocurable dosage and tissue toxicity's graph of a relation.

Radial extent and the schematic diagram of offset deviation when Fig. 2 is to carry out extracorporeal six field radiation.

Fig. 3 (a) is the schematic diagram in prior art after catheter air bag inflation.

Fig. 3 (b) is the schematic diagram in prior art before catheter air bag inflation.

Fig. 4 is the structural representation of an embodiment of this case pipe guide.

Fig. 5 is the schematic diagram of the different embodiment of this case fluid flow tubes structure length.

Fig. 6 (a) is the schematic perspective view of node unit.

Fig. 6 (b) is the front schematic view of node unit.

Fig. 6 (c) is the side schematic view of node unit.

Fig. 7 (a) is the schematic perspective view having the then embodiment of ring portion on node unit.

Fig. 7 (b) is the front schematic view having the then embodiment of ring portion on node unit.

Fig. 7 (c) is the side schematic view having the then embodiment of ring portion on node unit.

Fig. 8 (a) is the schematic diagram of outer ring structure embodiment.

Fig. 8 (b) is the schematic diagram that the then ring portion of node unit connects outer ring structure.

Fig. 8 (c) is the schematic diagram that the then ring portion of node unit connects outer ring structure.

Fig. 9 is the schematic diagram that node unit connects outer ring structure and the embodiment of outer layer element.

Figure 10 (a) is the schematic perspective view of the embodiment having prominent ring portion on node unit.

Figure 10 (b) is the front schematic view of the embodiment having prominent ring portion on node unit.

Figure 10 (c) is the side schematic view of the embodiment having prominent ring portion on node unit.

Figure 11 is to have the node unit of prominent ring portion to connect the schematic diagram of outer layer element.

Figure 12 is the schematic diagram that outer layer element expands.

Figure 13 is that the most independent breathing of outer layer element of this case pipe guide controls size to reach the signal of conformal tumor Figure.

Detailed description of the invention

Unless otherwise defined, all technology used herein and scientific terms for having usual skill institute in this field The same meaning understood.

The explanation of permeable below example is allowed and has usual skill in this field by this case " a kind of pipe guide " Solve its creation spirit, and can complete according to this.

The enforcement of this case is not limited it and implements kenel by the following example.

Asking for an interview an embodiment schematic diagram of Fig. 4 this case pipe guide 10, there is tubular structure 11 centre, in order to place the source of penetrating 12.A plurality of fluid flow tubes structures 13, the first direction of principal axis along tubular structure 11 is arranged, " the first of wherein this case embodiment Direction of principal axis ", it is the direction doing axle with the long limit of pipe guide.There is a plurality of node unit 15, along pipe on pipe guide 10 First direction of principal axis spread configuration of shape structure 11, wherein forms section 1a between, every section between each two adjacent node unit 15 1a and outer layer element 14 form a space 1b.A plurality of fluid flow tubes structures 13, its distal direction 18 of each leisure has an opening 17, and at its proximal direction 19, each there is independent control element 16, in certain embodiments, controlling element 16 can be doctor With helping Pu, syringe or injecting its type device etc..Control element 16 fluid (not shown) feeding fluid flow tubes structure 13 to be opened to it Mouthfuls 17, fluid between two adjacent node units 15 between section 1a occurs, be filled with space 1b so that outer layer element 14 is swollen Contracting, reaches the effect of location.Due to opening 17 position be each arranged at different between section 1a position so that different fluid flow tubes Structure 13 through respective opening 17 fluid is delivered to different between section 1a, reach outer layer element 14 respective breathing and each Self-controlled Breathing degree.

Wherein tubular structure 11, fluid flow tubes structure 13, outer layer element 14 made of soft and flexible, material can be silica Resin (silicone), latex (latex), plastic cement such as PVC, PU, PP, PE, PTFE etc. and other biological compatibility material or Its composition, and make outer layer element 14 can expand after filling.Tubular structure 11, fluid flow tubes structure 13 can be according to different affected part designs Different length and bore, section 1a between two adjacent sections dot element 15 formation, it is possible to be designed as the distance length not waited on demand.

In the embodiment of esophageal carcinoma, pipe guide 10 may be designed as length 900-1400mm, preferably length 900-1200mm.Tubular structure 11 external diameter may be designed as 2-6mm, preferably 5.3mm, and internal diameter can be 1-5mm, preferably 2.0- 2.1mm, can insert the size of the white pipe (lumencath) (the most graphic) assisting to put into the source of penetrating.

If affected part is rectum, then pipe guide 10 length may be designed as 300-600mm, preferably 400-600mm.Tubulose The design of structure 11 external diameter can be 6-15mm, preferably 10mm, and internal diameter can be 1-5mm, preferably 2.0-2.1mm, inserting Assist to put into the white size managing (lumencath) (not shown) in the source of penetrating.

Fluid flow tubes structure 13 is identical with the length of tubular structure 11 in certain embodiments, and at least an opening 17 is positioned at Section 1a between difference.The internal diameter of fluid flow tubes structure 13 can be between 0.2-3mm, and preferably internal diameter is 0.7mm.For esophageal carcinoma Embodiment in, the centre distance tubular structure center of fluid flow tubes structure 13 is 0.6-3mm, preferably 1.8-1.9mm.With In the embodiment of rectal cancer, the centre distance tubular structure center of fluid flow tubes structure 13 is 2-5mm, preferably 3.9mm.

The material of node unit 15 can be equally silica resin (silicone), latex (latex), plastic cement such as PVC, PU, PP, PE, PTFE etc. and other biological compatibility material composition, it is possible to add further and there is X-ray developing line or add sulfur The developing materials such as acid barium.In the embodiment of esophageal carcinoma, the length of node unit 15 can be 1-15mm, preferably 1-8mm, In the embodiment of rectal cancer, the length of node unit 15 can be 1-15mm, preferably 5-15mm.

For making between tubular structure 11 and node unit 15, between fluid flow tubes structure 13 and node unit 15, and outward Between layer elements 14 and node unit 15 the most airtight, make the smooth breathing of outer layer element, it is possible to use adhesive agent (not shown) is auxiliary Help.

In certain embodiments, a plurality of fluid flow tubes structures 13 may by single controlling element (the most graphic), such as with The pump-up device that computer controls, links multiple fluid flow tubes structure 13, and through valve, each distal direction 18 of independent control links Outer layer element 14.In the embodiment of esophageal carcinoma, the length of outer layer element 14 can be 5-20mm, preferably 16.5mm, can Selection is expanded to diameter 30mm or less.In in the embodiment of rectal cancer, the length of outer layer element 14 can be 20-50mm, Preferably 30mm, selectively-expandable to diameter 50mm or less.

Fig. 5 is the schematic diagram of the another kind of embodiment of this case pipe guide 10, and wherein fluid flow tubes structure 13 is the longest Spend different, make different fluid flow tubes structures 13 each communicate with different between section 1a, be filled with space 1b, reach outer layer element 14 Each breathing and each Self-controlled breathing degree.

Fig. 6 (a), Fig. 6 (b), Fig. 6 (c) are respectively the schematic perspective view of this case node unit 15, front schematic view, side Schematic diagram.Refer to Fig. 2 Yu Fig. 6 (a), Fig. 6 (b), Fig. 6 (c), node unit 15 is a hollow cylinder structure, wherein vacancy 33 It is available for tubular structure 11 along by node unit 15, the post jamb 31 of node unit 15 is provided with passage 32, makes fluid flow tubes Structure 13 can pass through node unit 15.The sky that between making between two adjacent node units 15, section 1a is formed with outer layer element 14 Between 1b can be airtight, it is provided that outer layer element 14 while breathing, also can make tubular structure 11 and fluid flow tubes because being filled with fluid Structure 13 is by node unit 15.

Fig. 7 (a), Fig. 7 (b), Fig. 7 (c) are respectively this case node unit 15 and have the schematic perspective view, just of then ring portion 41 Face schematic diagram, side schematic view；Fig. 8 (a), Fig. 8 (b), Fig. 8 (c) are that the then ring portion 41 of node unit connects outer ring structure 51 Schematic diagram.The most then ring portion 41 is a ring groove, can be combined, such as Fig. 8 with the outer ring structure 51 of Fig. 8 (a) Shown in (b), 8 (c).In certain embodiments, outer ring structure 51 can be the elastic tape of the elastic tight Shu Li of tool, or the life that tool is elastic Thing compatibility material, or not resilient plastics or metal etc..

Fig. 9 is the embodiment schematic diagram that node unit 15 connects outer ring structure 51 and outer layer element 14.As it is shown in figure 9, phase Two adjacent node units 15 are by then ring portion 41 and outer ring structure 51 fixed outer layer element 14, and form a space 1b, make Obtain outer layer element 14 breathing that can make this space 1b after fluid (not shown) enters this space 1b.In this embodiment, outer layer unit The quantity of part 14 can be 1, then the pressure segmentation given by the then ring portion 41 of outer ring structure 51 with node unit 15, reaches Between difference, the outer layer element 14 of section 1a can distinguish the purpose of breathing.

In the embodiment in figure 10, node unit 15 has prominent ring portion 71, and Figure 10 (a), Figure 10 (b), Figure 10 (c) are respectively For this case node unit 15 tool prominent schematic perspective view of ring portion 71, front schematic view, side schematic view.Figure 11 is node unit 15 when having prominent ring portion 71, and outer layer element 14 is connected to the schematic diagram in prominent ring portion 71.Outer layer element 14 be connected to two adjacent In the described prominent ring portion 71 of described node unit 15, between making to be formed between two adjacent described node units 15, section 1a is formed One airtight space 1b, allows the outer layer element 14 can be because being filled with fluid and breathing.In this embodiment, the quantity of outer layer element 14 can For multiple, the demand of regarding can be 4 to 16, is connected between different two adjacent node unit 15 section between being formed respectively. In Fig. 8 illustrate outer layer element 14 with film like encase between section 1a, wherein outer layer element 14 film thickness can be most preferably 0.1-2mm it Between.In the embodiment of esophageal carcinoma, the length of outer layer element 14 can be 5-50mm, preferably 5-20mm, in for rectum In the embodiment of cancer, outer layer element 14 length can be 5-50mm, preferably 20-50mm.

Figure 12 be this case pipe guide 10 outer layer element 14 can because of the existence of node unit 15 the showing of respective breathing It is intended to.This case is because can independently control whether different space 1b is filled with fluid and the amount being each filled with, therefore can independently control each The breathing degree of outer layer element 14, when when the varying in size of tumor growth of different sections, can be raw by patient body's intracavitary neoplasm The actual demand of long situation, is charged into less amount of fluid expansion outer layer in body cavity stenosis (because tumor is bigger or more prominent causes) Element 14, the shallow place of tumor growth more table (esophagus tube chamber is the narrowest) is then filled with relatively multi-fluid and makes outer layer element 14 degrees of expansion Become big, reach just can kill with less radiological dose the purpose of tumor, to reduce side effect.And outer layer element 14 is then in leading Time on pipe, because there being the design of node unit 15, it is available for precisely being engaged in after outer layer element 14 uses adhesive agent (not shown), changes Being apt to prior art when additional gas capsule is on conduit, easily having offset because sticking together place, and uneven after causing airbag aeration And the problem being likely to occur radiation focus.

This case is because of the design of outer layer element 14 with node unit 15, it is only necessary to a small amount of aeration quantity, can possess expansion effect, because of And when determining degrees of expansion, it is possible to select less swell increment, improve the shrinkage air bag before inflating such as Fig. 3 (b) prior art, Need to be filled with the problem that a certain amount of above fluid could maintain bladder shape.This case is also because of outer layer element 14 and node unit 15 Design, need not such as the additional air bag of prior art, cause enter body cavity time can and body lumen wall friction cause sufferer sense of discomfort very Damage to cavity wall, improve smooth degree when inserting the narrow cavity of sufferer.

Figure 13 is that the respective independent breathing of outer layer element 14 of this case pipe guide 10 controls size to reach conformal tumor group Knit the schematic diagram of 101.After being connected to after lotus formula therapeutic instrument 103, pipe guide 10 (clipped element), can be along tumor group Knit 101 sizes in tube chamber, determine which position outer layer element 14 to need breathing, and the size of breathing at, place into and penetrate Source 12, carries out brachytherapy.Owing to the outer layer element 14 of this case pipe guide 10 can each breathing so that pipe guide 10 can Conformal tumor tissues 101 so that when arranging treatment plan for sufferer, by increasing capacitance it is possible to increase the range of exposures of tumor tissues 101, is just reducing The often acceptable dose of tissue 102, increases sufferer cure rate, and reduces side effect.

The wherein position of outer layer element 14 breathing, and the size of breathing is according to captured by tumor imaging instrument 104 Image determines, tumor imaging instrument 104 includes X-ray imaging, fluorescent photoscope (fluoroscope), CT Scan (CT Scan), positron emission tomography (PET), single photon emission tomographic imaging (SPECT), NMR (Nuclear Magnetic Resonance)-imaging (MRI) etc..

Passing image location uses 2D planar system, takes front and two, side image, it is understood that there may be mistake spatially Difference, tends to the stereochemical orientation mode using CT Scan the most, and now pipe guide 10 is at intraluminal fixed effect Just seeming extremely important, due to the conformal tumor tissues of pipe guide 10 101, pipe guide 10 and tumor tissues 101 have approximation mutually The effect of tabling, has good fixed effect so that treatment plan is the most accurate, successfully solves sufferer because breathing and making Pipe guide 10 moves, or because carries out tumor imaging illumination procedure to the shifting carried out in the middle of the placement treatment procedure of radioactive source Problem that is dynamic, that reduce the precision for the treatment of plan.

In sum, with the Bonvoisin-Gerard Esophageal of known techniques, such as Elekta Applicator product, Standard Nasopharyngeal Applicator Set product, U.S. Patent Bulletin number US7384411B1, U.S. Patent Bulletin US6575932B1, China Patent Publication No. CN202387089U, U.S. Patent Bulletin Conduit number disclosed in US6527692B1 and U.S. Patent Bulletin number 5910101 etc. is compared, this case add fixed effect, Reduce the scope that normal structure is irradiated by lonizing radiation, reduce side effect, simultaneously because outer layer element 14 is by outer ring structure 51 and joint Then ring portion 41 segmentation of dot element 15, or segmentation in the way of possessing multiple outer layer element 14, reach section 1a between difference Outer layer element 14 can distinguish breathing, such as, have 4-16 the outer layer element 14 that can distinguish breathing, in multiple tumors, or more In the case of unrestrained property tumor, the present invention all can fix at needs, and relies on merely movement to penetrate source and treat multiple diffusivity cancer Disease section, it is not necessary to operation is repeated several times and takes considerable time the energy with sufferer；Also because of outer layer element 14 breathing degree, size Can independently control, the journey of its respective breathing of different outer layer elements 14 during use, according to the aspect of affected part tumor, can be determined Degree, size, with by conformal for whole section of tumor fixing, even if so patient respiratory or mobile time produce displacement, pipe guide 10 is because of Conformal secure tumor, can move without sliding along with tumor tissues, not result in the relative position change with tumor tissues, Increase the precision of doctor's treatment plan.

At any catheter treatment needing to strut body cavity, all may utilize the technical characteristic of the present invention, below will be with esophageal carcinoma As a example by the treatment of rectal cancer, describe step of applying, auxiliary art has usually intellectual and understands that the present invention can Can method of application, and in the case of without departing from this case claim, replace other and use steps to use the present invention:

Esophageal carcinoma:

Pipe guide 10 is inserted esophagus from nasal cavity.When outer layer element 14 not yet breathing, because of without additional air bag Interference, can smooth and easy by pipe guide 10 from nasal cavity to entering esophagus, therefore without putting into from oral cavity.Esophagus inserted by pipe guide 10 After, with adhesive tape sticking in nostril extenal fixation.

(lumen cath, not shown) will be managed in vain and insert the tubular structure 11 of pipe guide 10, until least significant end, with adhesive tape White pipe (not shown) is pasted fixing with tubular structure 11.

Again white pipe (not shown) opening is connected rear lotus formula therapeutic instrument 103, put into and can measure that to insert tube chamber relatively deep Source is penetrated in degree and the simulation can developed in CT image.

Capturing the image scout view (flat image of restructuring) at this position of patient, the distribution model in source is penetrated in viewing simulation Enclose, its range of tumor of flat image of randomized controlled treatment planning system computerized tomography image restructuring, determine that pipe guide 10 is corresponding Outer layer element 14 position expanded and degrees of expansion.Because this case pipe guide 10 has abundant outer layer element 14 (example: 8 Individual can the outer layer element of breathing), even diffusivity tumor, also without doing any movement after inserting pipe guide, this makes disease People also can be comfortable on without anesthesia when.

Scan computerized tomography image after being expanded by portion outer layer element 14, confirm that expanded size is suitable, adjust if needed Size, rescans computerized tomography image after the modification.

Computerized tomography image is sent to treatment planning systems, describes knub position when outer layer element 14 expands and tumor Scope, also can describe its surrounding normal tissue (such as pulmonary, heart, spinal cord etc.).

For patient's various tumor size shape, make 3D treatment plan (Rapid Dose Calculation), to guarantee that range of tumor obtains Enough dosage, and make the reception dosage of normal structure in safety range.

Perform treatment, bestow irradiation.

Rectal cancer:

Pipe guide 10 to rectum is put into from the anus of sufferer, and with adhesive tape sticking in anus extenal fixation pipe guide 10.

Put into white pipe (not shown) to the tubular structure 11 of pipe guide 10, until least significant end, will manage with adhesive tape that (figure is not in vain Show) paste fixing with tubular structure 11.

Computerized tomography image is sent to treatment planning systems, describes knub position when outer layer element 14 expands and tumor Scope, also can describe its surrounding normal tissue (women such as ovary and uterus；Male such as prostate, bladder etc.).

For patient's various tumor size shape, manufacture 3D treatment plan (Rapid Dose Calculation), to guarantee that range of tumor obtains Enough dosage, and make the reception dosage of normal structure in safety range.

Perform treatment, bestow irradiation.

The present invention need not the auxiliary of guide wire, can irradiate whole section of diffusivity tumor in a brachytherapy, it is not necessary to Repeat deployment catheter and radioactive source, sufferer can be avoided to breathe or the mobile change caused between conduit and tumor relative to position, shadow Ring treatment plan precision；Need not put in oral cavity and do not need sufferer is bestowed anesthesia during this case treatment esophageal carcinoma, add Not with additional gas capsule, but possess and the outer layer element 14 of breathing can reach therapeutic purposes with node unit 15 element such as grade, do not have General additional air bag can cause sufferer sense of discomfort even cavity wall to damage with body lumen wall friction when entering body cavity, is greatly promoted and inserts Smooth degree during the narrow cavity of sufferer, solves problem of the prior art, has reached more preferable effect.

Symbol description

Pipe guide 10

Tubular structure 11

Penetrate source 12

Fluid flow tubes structure 13

Outer layer element 14

Node unit 15

Control element 16

Opening 17

Distal direction 18

Proximal direction 19

Between section 1a

Space 1b

Post jamb 31

Passage 32

Middle vacancy 33

Then ring portion 41

Outer ring structure 51

Prominent ring portion 71

Tumor tissues 101

Normal structure 102

Rear lotus formula therapeutic instrument 103

Tumor imaging instrument 104

Tumor size GTV

Range of scatter CTV

Movement deviation scope ITV

Treatment bounds PTV

Claims

1. a pipe guide, it is characterised in that including:

One tubular structure；

A plurality of fluid flow tubes structures, respectively have a proximal direction and a distal direction, and along the one of described tubular structure One direction of principal axis is arranged；

A plurality of node units, along the described first direction of principal axis spread configuration of described tubular structure, the wherein adjacent institute of each two State and between node unit, form section between；And

One outer layer element, described outer layer element is coated with a plurality of described node units, makes to be formed between two adjacent node unit Described between section form a space.

2. pipe guide as claimed in claim 1, it is characterised in that described pipe guide has a plurality of described outer layer unit Part, a plurality of described outer layer elements be each respectively coated by by two adjacent described node units formed one described between section, make two Between individual adjacent described node unit formed described between section form a space.

3. pipe guide as claimed in claim 2, it is characterised in that the quantity of described fluid flow tubes structure is more than four； The quantity of described node unit is more than five；The quantity of described outer layer element is more than four.

4. pipe guide as claimed in claim 1 or 2, it is characterised in that described a plurality of fluid flow tubes structures in described closely Having a control element on extreme direction, described control element is for making the described distal direction of described fluid flow tubes structure link Described outer layer element, the most independent breathing of fragment position between described.

5. pipe guide as claimed in claim 1 or 2, it is characterised in that described a plurality of fluid flow tubes structures in described closely Having a plurality of control element on extreme direction, a plurality of described control elements are each independently disposed to described a plurality of fluid flow tubes On the described proximal direction of structure；The institute that described control element links for making the described distal direction of described fluid flow tubes structure State outer layer element, the most independent breathing of fragment position between described.

6. pipe guide as claimed in claim 1 or 2, it is characterised in that described node unit is a hollow cylinder structure, its Middle vacancy passes through described node unit for described tubular structure along described first direction of principal axis；And on the post jamb of described hollow cylinder Being provided with a passage along described first direction of principal axis, described passage passes through along described first direction of principal axis for described fluid flow tubes structure Described node unit.

7. pipe guide as claimed in claim 6, it is characterised in that outside the described hollow cylinder structure of described node unit Portion also has a then ring portion；Described outer layer element links through described then ring portion and described node unit, make two adjacent Between described node unit formed described between Duan Weiyi confined space.

8. pipe guide as claimed in claim 7, it is characterised in that also there is an outer ring structure, make described outer layer element button Together in described then ring portion.

9. pipe guide as claimed in claim 2, it is characterised in that described node unit is a hollow cylinder structure, wherein Vacancy passes through described node unit for described tubular structure along described first direction of principal axis；And edge on the post jamb of described hollow cylinder Described first direction of principal axis and be provided with a passage, described passage passes through institute for described fluid flow tubes structure along described first direction of principal axis State node unit；The outside of the described hollow cylinder structure of described node unit also has one and highlights ring portion；A plurality of described outside Layer elements is connected in the described prominent ring portion of two adjacent described node units along described first direction of principal axis, makes two adjacent institutes State between node unit formed described between section form a space.

10. pipe guide as claimed in claim 6, it is characterised in that the length phase of at least two described fluid flow tubes structures Different so that a plurality of described fluid flow tubes structure each communicate with different described between section.

11. pipe guides as claimed in claim 6, it is characterised in that also each have in a plurality of described fluid flow tubes structures Have an opening, wherein said aperture position be each arranged at different described between fragment position so that different described fluid flow tubes Structure through respective described opening fluid is delivered to different described between section.

12. 1 kinds of proximity radiotherapy systems, including:

Lotus formula therapeutic instrument after one；

A kind of pipe guide as described in any one of claim 1-11, is connected on described rear lotus formula therapeutic instrument；And

One brachytherapy sources, is released the described brachytherapy sources described tubulose to described pipe guide by described rear lotus formula therapeutic instrument In structure.

13. proximity radiotherapy systems as claimed in claim 12, it is characterised in that also there is a tumor imaging instrument, institute State rear lotus formula therapeutic instrument to determine to release described brachytherapy sources to described in described tubular structure according to described tumor imaging instrument Between fragment position.

14. proximity radiotherapy systems as claimed in claim 13, it is characterised in that described tumor imaging instrument includes X-ray In imaging, fluorescent photoscope, CT Scan, positron emission tomography, single photon emission tomographic imaging and NMR (Nuclear Magnetic Resonance)-imaging One or more.