JP2001046397A - Therapeutic laser irradiation device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent the erroneous irradiation of a catheter with a laser beam before the catheter is inserted into the living body by controlling the laser irradiation from a laser beam generating means in accordance with the information on the detections to whether an insertion part is inserted into the living body or not. SOLUTION: An operation sensor 115 is installed to the front surface of a main body 110 of the laser beam irradiation catheter 1 and the laser irradiation is controlled by using the detected light signal. A program for judging, by the light quantity measured, whether the laser beam irradiation catheter 1 exists in the living body or the outside of the living body is recorded in a ROM in a controller 6 and is executed under the control of a CPU. The value lower than the standard in-room light quantity of an operation room indicating the outside of the living body is used as the threshold light quantity to discriminate the outside of the living body from the inside of the living body where the light quantity is extremely little. When the optical sensor 115 checks that the catheter exists in the living body, a laser irradiatable lamp is lighted and when the laser beam exit portion is considered to exist on the outside of the living body, the irradiatable lamp is not lighted.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical laser irradiation apparatus for heating and treating only a target deep part of a living body.

[0002]

2. Description of the Related Art A long insertion portion is inserted into a living body by using a body cavity or by making a small incision, and the tissue is denatured, necrotic, or irradiated by irradiating the lesion with energy such as laser light.
Heat treatment devices that disappear by coagulation, cauterization or transpiration are known. This heating device generally treats a lesion site located at or near the surface of living tissue by directly irradiating energy thereto, but heat treatment for a lesion site located deep in the living tissue such as the prostate gland is performed. Is also used. For example, there is a transurethral microwave high temperature treatment. In this method, a catheter body with a built-in microwave antenna is transurethrally inserted into the urethra of the prostate, and cooling water is circulated through the catheter to irradiate microwaves while cooling the urethra to heat-treat the prostate. .

[0003]

[Problems to be Solved by the Invention]
No. 0 discloses a technique for proposing a method of coagulating and reducing a tumor or a part of a prostate tissue by laser irradiation. In this technique, a catheter body equipped with an inflatable balloon (balloon) at the tip is inserted into the prostatic urethra, and then the balloon is inflated by injecting a cooling liquid into the balloon to cool the urethral surface in contact with the balloon. Only the inside of the prostate is heated. In this case, while cooling the vicinity of the emission unit provided at the distal end of the insertion unit with a coolant, and protecting the vicinity of the surface layer of the living tissue from thermal damage,
Heat treatment of deep lesions. further,
The surface temperature at which the energy is irradiated is directly measured, and the laser light output and the like are controlled so that the living tissue does not excessively rise.

Therefore, in the above-mentioned heat treatment apparatus using laser light, although there are safety measures such as not to excessively raise the temperature of the living tissue irradiated with the laser light, the laser treatment is erroneously performed before the catheter is inserted into the living body. There were no safety measures to prevent light from being emitted, and only those who had attended the surgery were required to wear safety glasses to block laser light.

The present invention has been made in view of such problems of the prior art, and an object of the present invention is to prevent a laser beam from being erroneously irradiated before a catheter is inserted into a living body. A medical laser irradiation device is provided.

[0006]

In order to achieve the above object, a medical laser irradiation apparatus for carrying out the method of the present invention comprises:
It has the following configuration. That is, a medical laser irradiation apparatus including a laser light generating unit that generates laser light, and a unit that irradiates the living body with laser light from an insertion unit to be inserted into the living body to perform treatment, wherein the insertion unit is The detection device includes a detection unit that detects whether the laser light is inserted into a living body, and a control unit that controls laser irradiation from the laser light generation unit based on information detected by the detection unit.

[0007]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS (Embodiment 1) Hereinafter, FIGS.
The first embodiment will be described in detail with reference to FIG. FIG. 1 is a system configuration diagram of a medical laser irradiation apparatus 10 according to the present embodiment. The medical laser irradiation device 10 has a side-projection type laser light irradiation catheter 1 inserted into a living body, and the laser light guided from the laser light generation device 2 by an optical fiber 118 is applied to a housing 112. From living tissue 2
Irradiated toward zero. Laser irradiation catheter body 1
An optical sensor 115 for preventing erroneous laser irradiation when the laser light irradiation catheter 1 is outside the living body is installed near the surface of the surface 10 in contact with the housing 112.
The optical sensor 115 is installed at a position shown in the drawing so as not to receive the laser beam emitted from the laser reflecting section reflecting surface 127 installed in the housing 112 of the laser beam irradiating catheter 1. Further, a black plate 114 is provided around the lower portion of the optical sensor 115 so that the optical sensor is not affected by the lighting of the endoscope guide. Optical sensor 115
The optical signal detected by is transmitted to the control device 6. As a photosensor, a phototransistor, a photodiode or a cadmium sulfide photoconductive cell (CdS cell)
Are used. Further, the laser irradiation device main body 110 is provided with a plurality of lumens (not shown) for circulating the cooling liquid which are communicated with a housing 112 which is connected to the vicinity of the distal end thereof. Coolant feed tube 185 and coolant return tube 186
It is connected to the. The coolant circulating device 4 sends out a coolant at a set flow rate to the laser beam irradiation catheter 1 based on a control signal from the control device 6. Coolant temperature controller 5
Controls the temperature by heating or cooling the coolant based on a control signal from the control device 6. The motor 188 performs a rotational motion at a set rotational speed based on a control signal from the control device 6. The control device 6 includes an operation unit 8 as input means, a display unit 7 for displaying input information and device information, a control unit (not shown) for controlling each device, a storage device (not shown) for various information, and various information. Input / output device (not shown).

In the heating treatment by the laser of the present embodiment, the cooling liquid circulating device 4 supplies the cooling liquid feed tube 185.
The cooling liquid is supplied to the laser beam irradiating catheter 1 through the, the motor 188 rotates, and the laser beam generator 2 operates. The generated laser light is guided to the distal end portion of the laser light irradiation catheter 1, reflected by the reflecting portion reflecting surface 127, passes through the window, passes through the cover member 113, and is irradiated on the target point 40. At this time, the reflecting portion 127 changes the irradiation angle while reciprocating in the axial direction at a cycle of 1 to 3 Hz. However, since all the optical paths of the laser light intersect at the target point 40 inside the target portion 30, the target point In the case of 40, the amount of heat generated by continuous irradiation of the laser beam is large and the temperature is high. On the other hand, the living tissue 20
In the surface layer 21, the laser beam irradiation is intermittent and the amount of generated heat is small, so that it is maintained at a relatively low temperature and protected from the influence of laser beam heating.

FIG. 2 is a sectional view of the distal end portion of the laser beam irradiation catheter 1. As shown in FIG. 2, the laser light irradiation catheter 1 has a smooth reflecting portion reflecting surface 127 that reflects the laser light contained in the housing 112. The reflecting surface 127 is provided at the base of the laser beam irradiation catheter 1 via the arm 116.
(FIG. 1), and moves in the axial direction by moving the arm 116 in the axial direction of the main body 110. The drive unit 150 (FIG. 1) has a cam mechanism (not shown) that converts the rotational movement of the motor 188 (FIG. 1) into a reciprocating movement. The surface 127 is reciprocated in the axial direction of the main body 110. The housing 112 is formed of a hard tubular body having a window for laser beam irradiation, and is covered with a cover member 113 having good laser beam transparency.

FIG. 3 is a perspective view for explaining the structure of the reflecting surface 127 and the arm 116 of the laser beam irradiation catheter 1. The arm 116 is connected to the housing 112
It branches to the left and right inside, and supports the reflecting portion reflecting surface 127. The reflection surface 127 has a support 128 on one side and a pair of protrusions 133 on the other side. The support portion 128 is attached to the arm 116 so as to be freely rotatable, and can cope with a change in the reflection angle of the reflection portion 127. The protrusion 133 is provided on the housing 112.
Is fitted with a groove 132 arranged on the inner wall. Arm 1
Reference numeral 16 is connected to a drive unit 150 (FIG. 1) disposed at the base end of the laser beam irradiation catheter 1, and reciprocates the reflecting surface 127 in the axial direction of the main body 110. Therefore, the reflecting surface 127 of the reflecting portion is
2, the inclination angle is changed with the movement in the axial direction.

FIG. 4 is a diagram for explaining the relationship between the movement of the reflecting portion 127 and the direction in which the laser beam is applied. FIG.
As shown in the figure, the distance between the arm 116 and the non-parallel groove 132 at the position P2 is shorter than that at the position P1. Therefore, when the support portion 128 of the reflecting portion reflecting surface 127 moves from the position P1 to the position P2, the reflecting portion reflecting surface 127 is moved.
The projection 133 slides along the groove 132, and the inclination angle of the reflection surface 127 is adjusted. That is, the inclination angle of the reflecting surface 127 with respect to the axis of the main body 110 is reduced. Similarly, when the support portion 128 of the reflecting portion reflecting surface 127 moves from the position P2 to the position P3, the reflecting portion reflecting surface 12
The inclination angle of the body 7 with respect to the axis of the main body 110 is further reduced.

On the other hand, at the positions P1 to P3, the laser beam reflected by the reflecting surface 127 of the reflecting portion is directed to a target point 40 inside the target 30 of the target heating portion.
Focus on In other words, the laser beam is emitted to
0 is applied continuously, and other tissues such as the surface layer are applied intermittently. Therefore, the target point 40
Is heated by the applied laser beam to reach a desired temperature. On the other hand, other living tissues such as the surface layer generate little heat and are hardly heated because the irradiation time of the laser beam is short.

The laser beam irradiation catheter 1 has an arm 116 parallel to the axial direction of the main body 110 and a non-parallel groove 13.
By appropriately designing the relationship between the two and the shape of the groove 132, the present invention can be applied to a lesion site having a complicated shape. For example, the groove 132 is not limited to a straight line but may be a curved line.

FIG. 5 is a sectional view for explaining an example of use of the laser beam irradiation catheter 1. As shown in FIG. The distal end of the main body 110 is inserted into the body cavity 22 of the living body, and the housing 112 in which the reflective surface 127 is accommodated is brought into close contact with the lesion layer, that is, the surface layer 21 in the vicinity of the target region 30, which is a target heated region. At this time, it is desirable to directly confirm the position of the housing 112 with the endoscope 180. In addition,
Target point 40 in the longitudinal direction of body 110
Is the position of the entire laser light irradiation catheter 1 and the body 11
It is adjusted by moving in the longitudinal direction of zero. The target point 4 in the circumferential direction of the main body 110
The position of 0 can be adjusted by rotating the entire laser beam irradiation catheter 1 manually or automatically.

When irradiating the laser beam, the reflecting surface 1
27 is reciprocated in the axial direction while changing the angle at a period of 0.1 to 5 Hz, preferably 1 to 3 Hz. In this manner, the optical path of the laser beam is continuously changed, but all are irradiated so as to intersect at the target point 40. Thus, the target point 40 and its vicinity are heated by the irradiated laser beam and reach a predetermined temperature. Thus, while suppressing the temperature rise of the surface layer 21,
Only the temperature within the desired target site 30 can be increased.

The radiated laser light is preferably divergent light, parallel light or convergent light. Further, an optical system for turning the laser light into convergent light may be provided in the optical path of the laser light. The laser beam to be used is not particularly limited as long as it has a depth of a living body.
１1300 nm or 1600 to 1800 nm is preferred. For example, gas lasers such as He-Ne lasers, Nd-
A solid-state laser such as a YAG laser or a semiconductor laser such as a GaAlAs laser can be applied to the laser light generator 2 that generates laser light having the above-mentioned wavelength. The diameter of the insertion portion of the laser beam irradiation catheter 1, that is, the outer diameter of the main body 110 is not particularly limited as long as it can be inserted into the body cavity 22.
However, the outer diameter of the main body 110 is preferably about 2 to 20 mm, more preferably 3 to 8 mm.

FIG. 6 is a flowchart showing a laser mis-irradiation prevention control system in a treatment preparation stage when performing a heating treatment using the medical laser device of the first embodiment. In the first embodiment, an optical sensor 115 is installed on the surface of the laser light irradiation catheter 1 main body 110 to prevent erroneous laser irradiation when the laser light irradiation catheter 1 is outside the living body, and laser irradiation is performed using a detected optical signal. Control. In this example, it is determined whether the laser beam irradiation catheter 1 is inside the living body or outside the living body based on the measured light amount. A program for performing this processing is recorded in, for example, a ROM installed in the control device of FIG. 1 and executed under the control of the CPU.

First, as a preparation for the medical laser device, in step 10, a limit light amount is input. Here, the limit light amount is an amount to be distinguished from the inside of a living body at the time of surgery, and is used as a limit light amount that is lower than a standard indoor light amount of an operating room indicating outside the living body, and is distinguished from a living body with extremely small light amount. Next, the optical sensor 115 is checked before the laser irradiation device 1 is inserted into the urethra. In step 30, the light amount of the optical sensor 115 is measured, and if it is confirmed that the measured value is equal to or smaller than the set value and indicates that the optical sensor 115 is outside the living body, step 40 is performed.
Turns on the insertable lamp of the laser irradiation catheter 1. On the other hand, if the measured value of the optical sensor 115 is equal to or larger than the set value in step 30, the insertable lamp is not turned on in step 50, and the optical sensor 115 is inspected and repaired in step 60. Next, in step 70, the light amount of the optical sensor 115 is measured, and when it is confirmed that the measured value is equal to or less than the set value and the optical sensor 115 is in the living body, the laser irradiable lamp is turned on in step 80, and Finish the safety check. On the other hand, if the measured value of the optical sensor 115 is equal to or more than the set value in step 70 and it is considered that the laser light emitting portion is outside the living body, the irradiable lamp is not turned on in step 90, and the laser irradiation position is corrected in step 100. After that, the process returns to step 110 again to measure the light amount again.

(Embodiment 2) FIG. 7 is a system configuration diagram of Embodiment 2 of the medical laser irradiation apparatus 10, and FIG.
5 is a flowchart showing a laser mis-irradiation prevention control system in a treatment preparation stage of the medical laser irradiation device 10. A description of common points with the first embodiment will be omitted, and only different points will be described. In the first embodiment, it is determined whether the main body 110 of the laser light irradiation catheter 1 is inside or outside the living body using the optical sensor 115 in order to prevent erroneous laser irradiation. A temperature sensor 117 is used instead of the sensor 115. On the surface of the main body 110 of the laser beam irradiation catheter 1 in FIG.
The temperature sensor 117 is installed, and the detected temperature signal is transmitted to the control device 6. As the temperature sensor 117, a temperature sensor such as a thermistor, a platinum resistance thermometer, or a thermocouple is used.

Next is a flowchart. In this example,
Whether the main body 110 of the laser beam irradiation catheter 1 is inside or outside the living body is determined from the measured temperature. Here, the limit temperature input in step 15 is lower than the patient's body temperature and higher than the operating room temperature. In step 35, the temperature is measured, and if it is confirmed that the measured value is equal to or less than the set value and that the temperature sensor correctly indicates that the temperature sensor is outside the living body, the insertable lamp of the laser irradiation device 1 is turned on in step 40. On the other hand, if the measured value of the temperature sensor is equal to or more than the set value in step 35, the irradiation lamp is not turned on in step 50, and the sensor is repaired and repaired in step 60. Next, in step 75, the temperature of the temperature sensor is measured, and if it is confirmed that the measured value is equal to or less than the set value, the laser irradiation enable lamp is turned on in step 80, and the safety confirmation before laser irradiation ends. On the other hand, if the measured value of the temperature sensor is equal to or more than the set value in step 75, the irradiation lamp is not turned on in step 90, the laser irradiation position is corrected in step 100, and the process returns to step 75 again to measure the temperature again. Note that, instead of the temperature sensor 117 used in this example, a pressure sensor may be installed at the temperature sensor installation position, and the outside of the living body may be distinguished from a pressure change that occurs when the laser beam irradiation catheter 1 is inserted into the urethra. Here, a diaphragm pressure sensor or the like is used as the pressure sensor.

(Embodiment 3) FIG. 9 is a system configuration diagram of Embodiment 3 of the medical laser irradiation apparatus 10, and FIG.
5 is a flowchart showing a laser mis-irradiation prevention control system in a treatment preparation stage of the medical laser irradiation device 10. The description of the common points between the first embodiment and the second embodiment will be omitted, and only different points will be described. Embodiment 1
In the second embodiment, the optical sensor 115 or the temperature sensor 117 is used alone to determine whether the laser irradiation device is inside the living body or outside the living body to prevent erroneous laser irradiation. The aforementioned optical sensor 115
And the temperature sensor 117 are used together, and the inside and outside of the living body are more accurately determined by a double check. Note that the flowchart of FIG. 10 is created by combining the functions of FIGS. 5 and 7, and there are no particular steps added. In the third embodiment, an optical sensor and a temperature sensor are installed as a double check, but any combination of an optical sensor and a pressure sensor, a temperature sensor and a pressure sensor, or all of them may be used as a triple check. is there. (Embodiment 4) FIG. 11 is a system configuration diagram of Embodiment 4 of the medical laser irradiation apparatus 10, and FIG. 12 is a flowchart showing a laser erroneous irradiation prevention control system in a treatment preparation stage of the medical laser apparatus 10. It is. The description of the common points with the above-described third embodiment will be omitted, and only different points will be described. In the third embodiment, the optical sensor 115 and the temperature sensor 117 are used in combination for judging the inside and outside of the living body, and the prevention of erroneous laser irradiation is strengthened by a double check. In addition to the mechanism, by managing the coolant, safety measures are taken to protect the lesion site due to lack of coolant and the vicinity of the surface layer from thermal damage. Here, a flow rate sensor 187 is installed in the cooling liquid circulation device 4 of the medical laser irradiation apparatus 10, and the flow rate sensor 187 includes a flow rate sensor such as a flow type flow sensor, an electromagnetic flow meter, and a laser flow meter. Used.

The flowchart of FIG. 12 is different from the flowchart of FIG. 9 in that steps related to the flow sensor 187 are added. First, in step 16, the minimum required flow rate required for the heat treatment is input as the limit flow rate. Also, before checking each sensor and before inserting the laser irradiation apparatus 1 into the living body, the flow rate sensor 187 is activated in step 36, and it is checked in step 37 whether the coolant flow rate is flowing by a predetermined amount. At 40, the insertable lamp is turned on. If the required flow rate is not flowing, the flow rate abnormality lamp is turned on in step 38, and the cooling fluid circulation device 4 is inspected in step 39 so that an appropriate flow rate flows. These safety measures can prevent erroneous laser irradiation and unexpected damage.

[0023]

According to the present invention, by providing a sensor in a medical laser irradiation apparatus, it is possible to prevent unexpected damage to a part other than a treatment site due to erroneous laser irradiation when a laser irradiation catheter is outside a living body. Is possible.

[Brief description of the drawings]

FIG. 1 is a system configuration diagram of a medical laser device 10 according to a first embodiment.

FIG. 2 shows a laser beam irradiation catheter body 1 according to the first embodiment.
FIG. 10 is a cross-sectional view of the vicinity of the tip of No. 10;

FIG. 3 shows a reflection surface 12 of the reflection portion of the laser beam irradiation catheter 1.
FIG. 7 is a perspective view for explaining the structures of a arm 7 and an arm 116.

FIG. 4 is a reflection surface 12 of the reflection part of the laser beam irradiation catheter 1;
FIG. 7 is a diagram for explaining a relationship between the movement of a laser beam 7 and a laser beam application direction.

FIG. 5 is a cross-sectional view illustrating an example of use of the laser beam irradiation catheter 1, showing a vicinity of a distal end inserted into a living tissue.

FIG. 6 is a flowchart illustrating a laser mis-irradiation prevention control system in a treatment preparation stage when performing a heat treatment using the medical laser irradiation apparatus 10 of the first embodiment.

FIG. 7 is a system configuration diagram of the medical laser irradiation apparatus 10 according to the second embodiment.

FIG. 8 is a flowchart showing a laser mis-irradiation prevention control system in a treatment preparation stage when performing a heat treatment using the medical laser irradiation apparatus 10 of the second embodiment.

FIG. 9 is a system configuration diagram of the medical laser irradiation apparatus 10 according to the third embodiment.

FIG. 10 is a flowchart showing a laser mis-irradiation prevention control system in a treatment preparation stage when performing a heat treatment using the medical laser irradiation apparatus 10 of the third embodiment.

FIG. 11 is a system configuration diagram of a medical laser irradiation apparatus 10 according to a fourth embodiment.

FIG. 12 is a flowchart illustrating a laser mis-irradiation prevention control system in a treatment preparation stage when performing a heat treatment using the medical laser irradiation apparatus according to the fourth embodiment.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 10 Medical laser irradiation apparatus 1 Laser irradiation catheter 110 Main body 112 Housing 114 Black plate 115 Optical sensor 118 Optical fiber 150 Drive unit 185 Coolant feed tube 186 Coolant return tube 188 Motor 189 Cable 2 Laser light generator 3 Drive power supply Reference Signs List 4 cooling liquid circulation device 5 cooling liquid temperature controller 6 control device 20 living tissue 21 surface layer 30 target part 40 target point

Continued on front page F term (reference) 4C026 AA03 AA04 BB01 BB04 BB06 BB07 BB08 DD03 DD06 FF17 FF34 GG02 GG07 GG08 HH16 HH24 4C082 RA05 RC01 RC03 RC06 RC08 RC09 RE17 RE35 RG03 RG06 RJ02 RJ07 RJ08 RL08

Claims (6)

[Claims] A laser beam generating means for generating a laser beam;
Means for irradiating laser light into the living body from an insertion portion to be inserted into the living body to perform treatment, wherein the detecting means detects whether or not the insertion portion has been inserted into the living body. And a control means for controlling generation of laser light from the laser light generation means based on information detected by the detection means. 2. The medical laser irradiation apparatus according to claim 1, wherein said detecting means includes an optical sensor for detecting that the insertion portion is inserted into a living body and is shielded from light. 3. The medical laser irradiation apparatus according to claim 1, wherein said detecting means includes a temperature sensor for detecting a temperature of the living body when said insertion portion is inserted into the living body. 4. The medical laser irradiation apparatus according to claim 1, wherein said detecting means includes a pressure sensor for detecting a pressure of the living body when the insertion portion is inserted into the living body. 5. The medical laser irradiation apparatus according to claim 1, wherein a cooling liquid is circulated in the insertion section having the detection means. 6. The insertion section having the detection means has a drive source for moving a laser reflecting section reflecting surface, and is capable of laser reflection while the laser reflecting section reflecting surface is moving. The medical laser irradiation device according to claim 1 or 5, wherein