CN114469329A - 一种用于治疗ggo的微波消融天线 - Google Patents
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Abstract
本发明涉及一种用于治疗GGO的微波消融天线,具有位于天线前端的辐射器,和套设于辐射器的辐射器罩,辐射器罩的前端为钝头,辐射器罩的侧壁设置有凹槽,所述凹槽靠近辐射器进行设置。由于辐射器罩的前端采用钝头设计,其特殊的非穿刺型外形使得天线在肺组织内可以自由穿行又不会刺破肺内的血管和支气管,并且GGO内存在的肿瘤血管不会被钝形的头部损伤而导致出血,降低了因肺内出血导致病灶无法识别而导致的手术失败率,同时避免了肿瘤细胞通过穿刺通道和出血血管扩散的可能性。并且在辐射器罩的侧壁设置有凹槽,GGO消融完成后,该处组织呈外凸状,使其更容易被找到,提高了活检取样的准确性。
Description
本申请为CN201810588541.9的分案申请。原申请的申请日为2018.06.08,申请号为201810588541.9,发明创造名称为《一种非穿刺型微波消融天线及其应用》。
技术领域
本发明涉及一种微波消融天线及其应用,属于微波消融技术领域。
背景技术
随着现代科技与肿瘤学的进步,近十年来,国内外微波肿瘤消融技术取得了突破性的进展。随着这种真正微创的肿瘤局部治疗手段的广泛应用,目前热消融治疗已经成为临床治疗指南内一线的首选治疗方式,肝癌、、肺癌、甲状腺腺瘤更是微波消融的热点领域。微波肿瘤消融是利用微波能作用组织即可产生热效应,在数分钟到十数分钟的时间内,其热场中心温度可达100℃以上,肿瘤组织在瞬间高温下被凝固、灭活,达到肿瘤消融治疗的目的。微波肿瘤消融术是将微波消融针介入人体组织的病灶,由其前端持续发射微波能,以实施手术,因其效率高,创口小,并且对组织的作用深度及范围大小均可控,适用于全身实体肿瘤的消融手术。
肺磨玻璃影(GGO,ground glass opacity)在胸部 CT 表现为密度轻度增高的云雾状淡薄影/圆形结节,样子像磨砂玻璃一样,所以叫磨玻璃影。GGO 可以是弥漫性散在生长,也可以仅聚集在局部,看起来像一个小磨玻璃结节。一般而言,弥漫性生长的多数是良性病变,局灶性生长的很可能是肺癌。随着CT的普及和临床应用,尤其是在体检中的广泛应用,全球的GGO呈爆发式的增长趋势。由于CT检查的便捷性,GGO病灶已经明确定义为癌前病变或早癌,已经有公认的影像学标准进行分期并指导临床的治疗。
传统GGO治疗的金标准是外科切除,目前临床上广泛采用的是胸腔镜下的肺部分切除术,由于GGO组织的特殊性,一般术前在肺部插入定位装置(类似于钩子形状的金属物体)达到GGO处,然后进行手术。虽然胸腔镜手术外观创口较小,但其手术方式仍然是外科切除,为了切除一个直径一厘米的小病灶,往往需要切除周围一整块楔形的肺组织,同时由于胸壁和胸膜组织的损伤,可能对病人造成极大痛苦,不利于病人的康复。微波消融技术出现之后,一般是首先通过穿刺,对细胞进行活检,然后再进行微波消融。活检和消融使用的都是穿刺型的针头,尖锐的针尖可能损伤血管和支气管,一旦血管被刺破,流出的血液会使得GGO难以在影像下清晰识别,增加了手术难度。而且活检针的突刺会刺破GGO的整个组织,导致正常组织与肿瘤细胞之间天然的屏障被打破同时由于出血,癌细胞也可能会进入血液系统到达身体其他组织从而导致扩散。因此这种手术方法相对于胸腔镜手术而言,虽然最大限度的减少了正常肺组织的损伤,同时也给病人带来的痛苦较少,但存在肺部出血导致的GGO难以清晰识别问题和癌扩散风险。
发明内容
本发明所要解决的技术问题是,克服现有技术的上述缺点,提供一种用于治疗GGO的微波消融天线,可不刺破肿瘤组织及内部的血管而直接进行微波消融,尤其适合于GGO的治疗。
为了解决以上技术问题,本发明提供的一种用于治疗GGO的微波消融天线,具有位于天线前端的辐射器,和套设于所述辐射器的辐射器罩,其特征在于:所述辐射器罩的前端为钝头。使得天线在插入肺部肺组织内不会刺破肺内的血管和支气管。同时能够用钝形的针尖对病灶进行挤压推移,利用GGO的组织特性接近肺组织,富有弹性的特点,使得病灶进一步的压缩,变小后包绕在消融针的头端,能够以更小的消融范围彻底杀灭肿瘤,同时不穿透病灶,病灶中央无贯通的中央针道,避免中央的针道及针道旁严重变性的组织对病理活检采样的影响。
进一步的,所述辐射器罩的侧壁设置有凹槽,所述凹槽靠近辐射器进行设置。
此外,本发明还要求保护所述非穿刺型微波消融天线,在肺部毛玻璃样变(GGO)的微波消融治疗上的应用。采用非穿刺型微波消融天线实施肺部毛玻璃样变(GGO)的微波消融治疗,通过挤压病灶使其压缩并包绕在消融针的头端,减少消融范围保护正常肺组织,并避免病灶中央消融针道对病理活检取样的影响。
由于辐射器罩的前端采用钝头设计,其特殊的非穿刺型外形使得天线在肺组织内可以自由穿行又不会刺破肺内的血管和支气管;由于肺组织的特殊性,即便辐射器罩前端为钝头,天线也能轻易的插入肺部GGO组织内部;并且GGO内存在的肿瘤血管不会被钝形的头部损伤而导致出血,降低了因肺内出血导致病灶无法识别而导致的手术失败率,同时避免了肿瘤细胞通过穿刺通道和出血血管扩散的可能性,更符合目前肿瘤治疗中的no touch原则。
钝形的前端可以挤压GGO病灶而不穿过GGO,使得病灶变得致密同时体积也明显缩小,减少消融的范围最大限度的保护肺组织。消融手术完成后,再对GGO组织进行活检,可以更好的避免穿刺导致的出血,提高活检采集的标本量,用于确定GGO的病理组织类型和浸润程度。由于本发明不同于以往常规的穿过病灶再消融的传统模式,更避免了病灶中间的消融针道对病理活检取样对影响。通过前期的动物实验证实了钝形非穿刺型头端在肺组织的通过性和安全性,临床 GGO微波消融后的活检也证实了消融后活检的阳性率、标本长度、并发症发生率均优于消融前的病理活检。
可见,使用本发明微波天线对GGO进行治疗时,避免肺部出血,可在不刺破GGO组织的情况下完成消融治疗,具有更高的安全性;并且在辐射器罩的侧壁设置有凹槽,GGO消融完成后,该处组织呈外凸状,使其更容易被找到,提高了活检取样的准确性。
附图说明
下面结合附图对本发明作进一步的说明。
图1是实施例一微波消融天线前端部分剖视图。
图2是消融前的肺部影像。
图3是消融过程中的肺部影像。
图4是实施例二微波消融天线前端部分剖视图。
图中标号示意如下: 1-辐射器,2-辐射器罩,3-针杆,4-外导体,5-内导体,6-介质管, 7-第一间隙,8-第二间隙,9-凹槽,10-介质套管,11-堵水轴,12-引水管。
具体实施方式
为使本发明实施例的目的、技术方案和优点更加清楚,下面将结合本发明实施例中的附图,对本发明实施例中的技术方案进行清楚、完整地描述。
实施例一
如图1所示,本实施例用于治疗GGO的微波消融天线,具有位于天线前端的非穿刺型辐射器,和套设于辐射器1的辐射器罩2。辐射器罩2的整体由弹性材料制作而成。本例中辐射器罩2使用PI制作,除此之外,也可以采用聚醚醚酮(PEEK)或锆瓷(非弹性材料)制作而成。采用弹性材料的优势在于:当天线插入肺部后,不会损伤血管或支气管,不会引起肺部出血。因此,较优的方案是,至少辐射器罩的前端由弹性材料制作而成,即可满足本发明的设计要求。辐射器罩的厚度为0.35mm ,辐射器罩外涂覆有防粘黏涂层。当然,由于前端采用钝头设计(非穿刺型),因此锆瓷制作而成辐射器罩也能够满足本发明的设计要求。
辐射器1前端的形状可以是弧面,也可以是平面,或弧面与平面的组合,或弧面与弧面的组合,或平面与平面的组合。如图1所示的本实施例中,辐射器1采用圆柱形结构。辐射器的长度为180mm,直径为1.3mm。
本实施例还给出了天线前端的具体结构。本发明天线还包括设置于辐射器罩2后部的针杆3,和贯穿设置于针杆3内的同轴电缆,同轴电缆具有内导体5和外导体4。辐射器1具有向后开设的孔,同轴电缆的内导体5插入该孔内与辐射器1固定。本例中,内导体5与辐射器1采用焊接固定,除此之外还可以采用机械压合固定,确保内导体5与辐射器1之间为导电连接。辐射器1与同轴电缆外导体4固定连接(辐射器与同轴电缆外导体之间也为导电连接)。本实施例天线的内部结构及参数使得微波辐射的中心能够更加靠近天线的前端,有利于GGO的消融治疗。
由于微波辐射中心更加靠近天线的前端,加上天线较细,因此传统的水冷结构无法在本实施例天线中应用。因此,发明人设计了一种新颖的微波消融能天线的水冷结构。
具体来说,在针杆内设置一介质管10,套设于辐射器1和同轴电缆外。介质管6的壁厚范围为0.02-0.04mm。介质管6选用聚醚醚酮制成。介质管6前端或/和前端的侧壁开孔,作为冷却水的进出水孔;介质管6与辐射器罩2,以及介质管6与针杆3之间形成第一间隙7,该第一间隙7作为冷却水的进水通道;介质管6与辐射器1,以及介质管6与同轴电缆外导体5之间形成第二间隙8,该第二间隙8作为冷却水的回水通道。针杆3后端设置进水腔和出水腔,进水腔与进水通道相连,出水腔与回水通道相连,进水腔通过管路连接冷却水的水源,出水腔则通过管路连接抽水装置,通过抽水装置工作,将冷却水从进水腔抽入进水通道,接着通过介质管的进出水孔进入回水通道,然后进入出水腔后被抽走,实现水冷。冷却介质也选用去离子水或生理盐水。
当然,将第二间隙8作为冷却水的进水通道,第一间隙7作为冷却水的回水通道也是一种可行的替换方案。本实施例选用抽水装置为冷却水提供流动的驱动力,是考虑到进水通道和回水通道的截面积较小,如果采用水泵驱动水流会带了阻力较大的问题,采用抽水装置则更容易实现。当然采用水泵进行驱动也是一种可行的替换方案。
发明人实践表明,GGO组织的DNA在消融前后未发生变化,因此发明人设想,如果能够把对GGO的活检步骤调整至消融后进行,则会避免传统活检过程中GGO组织细胞的破损,杜绝了癌细胞转移的风险。
为了更精准的对消融后GGO组织的活检采样,本实施例天线,在辐射器罩2的侧壁设置有凹槽9,凹槽9靠近辐射器1进行设置。由于肺组织的特性,设置有凹槽9的辐射器罩2插入肺部后,凹槽9立刻被肺组织填满。微波消融使得凹槽处的肺组织被灼烧固化,拔出天线后,凹槽处的肺组织呈现外凸,能够轻易地在影像上被识别,对外凸的组织进行活检采样,即可获得微波辐射中心附近的组织取样。
发明人使用实施例一微波消融天线进行了GGO的消融实验(非公开)。图2和图3为消融前和消融过程中的肺部影像。图2和图3的中央靠右侧白色区域为GGO,从图3中可看出,微波消融天线顶住GGO并使其发生形变(但未刺破病灶),使得病灶变得致密同时体积也明显缩小,,减少消融的范围,因此采用更低能量的微波辐射能量即可把整个病灶凝固,最大限度的保护肺组织。传统的微波消融天线的微波都是向后辐射,本实施例天线的特殊结构,使得辐射中心位于天线的前端且以向前辐射能量为主,其辐射能量正好与被顶变形的GGO相匹配。因此,本发明天线更够更好的适应GGO的无损消融(不穿透病灶内部和外界的消融方式),将肿瘤完全消融而不造成肿瘤内部和外部的通道,也不会造成加热后内部高压导致肿瘤内部的体液等液体释出。
实施例二
如图4示,该天线具有金属材质的辐射器1(头部前端为弧面),套装在该辐射器1后方的介质套管10和套装于介质套管10后端的针杆3,针杆3内贯穿设置有同轴电缆,辐射器1后端与同轴电缆的内导体5相连(导电连接),辐射器1后端与同轴电缆外导体4之间形成天线发射窗口。引水管12设置在同轴电缆和针杆3之间,其前端与堵水轴11固定。引水管12与同轴电缆之间的间隙形成进水道,引水管与针杆之间的间隙形成回水道。
上述实施例列举了两种辐射器前端的形状(平头和圆头),除此之外,还可以采用其他形式,比如弧面与弧面的组合,平面与平面的组合,弧面与平面的组合等等,辐射头部前端的形状相对平滑,使得辐射头不具有穿刺功能的形状均可实现本发明目的,本发明实施例不再一一举例。而辐射器罩的前端也同样可以采用圆头或平头。当辐射器罩采用弹性材料时,其前端形状大致与辐射器前端一致,当辐射器罩采用非弹性材料时,前端采用平头或圆头皆可。
此外,本发明还要求保护上述微波消融天线在GGO微波消融治疗中的应用。
除上述实施例外,本发明还可以有其他实施方式。凡采用等同替换或等效变换形成的技术方案,均落在本发明要求的保护范围。
Claims (9)
1.一种用于治疗GGO的微波消融天线,具有位于天线前端的辐射器,和套设于所述辐射器的辐射器罩,所述辐射器罩的前端为钝头,其特征在于:辐射器罩的侧壁设置有凹槽,所述凹槽靠近辐射器进行设置。
2.根据权利要求1所述用于治疗GGO的微波消融天线,其特征在于:所述凹槽用于在微波消融后使得所述凹槽处的肺组织被灼烧固化呈现外凸,能够轻易地在影像上被识别。
3.根据权利要求1所述用于治疗GGO的微波消融天线,其特征在于:所述辐射器罩的整体或前端由弹性材料制作而成。
4. 根据权利要求1所述用于治疗GGO的微波消融天线,其特征在于:辐射器的长度范围为160-200mm,直径范围为1.1mm-1.5mm,辐射器罩的厚度范围为 0.2 mm-0.5mm。
5.根据权利要求1所述用于治疗GGO的微波消融天线,其特征在于:还包括设置于辐射器罩后部的针杆,和贯穿设置于针杆内的同轴电缆,所述同轴电缆具有内导体和外导体,所述内导体与辐射器固定,一介质管套设于所述辐射器和同轴电缆外,介质管前端或/和前端的侧壁开孔,作为冷却水的进出水孔;所述介质管与辐射器罩,以及介质管与针杆之间形成第一间隙;介质管与辐射器,以及介质管与同轴电缆外导体之间形成第二间隙;所述第一间隙作为冷却水的进水通道,第二间隙作为冷却水的回水通道;或者所述第二间隙作为冷却水的进水通道,第一间隙作为冷却水的回水通道。
6.根据权利要求5所述用于治疗GGO的微波消融天线,其特征在于:所述辐射器具有向后开设的孔,同轴电缆的内导体插入该孔内与辐射器固定。
7.根据权利要求5所述用于治疗GGO的微波消融天线,其特征在于:所述同轴电缆的内导体与辐射器之间采用焊接固定或压合固定。
8. 根据权利要求5所述用于治疗GGO的微波消融天线,其特征在于:所述辐射器与同轴电缆外导体固定连接, 辐射器与同轴电缆外导体之间为导电连接。
9.根据权利要求6所述用于治疗GGO的微波消融天线,其特征在于:所述介质管选用聚醚醚酮制成,所述介质管的壁厚范围为0.02-0.04mm。
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