JP2006271828A - Medical treatment device and its usage - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To control irradiation intensity on a living body surface so as not to damage normal areas except affected areas. <P>SOLUTION: The device comprises a light source 102 to output light, an irradiation part 110 to irradiate the affected area 104 with the light from the light source 102, an optical fiber 106 to connect the light source 102 and the irradiation part 110, and a light intensity controlling part 120 to control the light intensity on the living body surface 105 between the affected area 104 and the irradiation part 110. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a medical treatment apparatus capable of performing treatment while adjusting the irradiation intensity of light so as not to damage a healthy part other than the lesion part as much as possible when treating a lesion part in a deep part of a living body, and a method of using the medical treatment apparatus About.

  Photochemical therapy (PDT, also called photodynamic therapy) has been studied for application to various treatments in addition to endoscopic treatment of early cancer. PDT is a PDT drug solution consisting of a photosensitizer (photosensitizer) such as a porphyrin derivative, administered by a method such as intravenous injection, and selectively absorbed and accumulated in a lesion such as a cancer tissue to be treated. This is a treatment method in which a lesion is injured by irradiating a laser beam or the like later. That is, PDT is a treatment method that utilizes the property that PDT drug solution is selectively accumulated in a lesion and the property that is sensitized by light.

  In PDT, controlling the intensity of irradiation light (irradiation energy density) is an important factor for selecting a treatment site. This is because simply irradiating light toward the lesioned part may cause damage to the healthy part due to the sensitization effect of light.

  As a method of adjusting the intensity of light to be irradiated, there are a method of changing the intensity of light output from the light source by adjusting the power of the light source, and a method of changing the irradiation spot diameter by adjusting the irradiation distance of the light to the living body. is there.

  However, the method of changing the light intensity by adjusting the power of the light source not only takes time to stabilize the light intensity, but also has a drawback that it is not suitable for fine adjustment. In addition, the method of changing the irradiation spot diameter by adjusting the irradiation distance needs to constantly adjust the distance from the living body, and depends largely on the skill of the operator, so the PDT that requires precise distance adjustment, In particular, there is a disadvantage that the lesion is in a deep part and is unsuitable for PDT when the lesion must be treated without damaging the shallow healthy part.

  The present invention has been made to eliminate such conventional drawbacks, and in the treatment of lesions in the deep part of the living body, the irradiation intensity of light so that the healthy part other than the lesions is not damaged as much as possible. It is an object of the present invention to provide a medical treatment apparatus that can be treated while adjusting the above and a method for using the apparatus.

  In order to achieve the above object, a medical treatment apparatus according to the present invention is a medical treatment apparatus including a light irradiation unit that emits light, and the light irradiation unit includes a light source that outputs light, and the light source. Provided between the light source and the light irradiation unit, a light irradiation unit for irradiating light from the light source toward the lesioned part, an optical fiber connecting the light source and the light irradiation part, and the lesioned part and the light. And a light intensity adjusting unit that adjusts the intensity of light on the surface of the living body between the irradiation unit and the irradiation unit.

  A method for using the medical treatment apparatus according to the present invention for achieving the above object is the method for using the medical treatment apparatus according to claim 1, wherein the light is irradiated from the light irradiation unit toward the lesioned part. Irradiation, detecting the surface condition of the surface of the living body, and light output from the light source by a light intensity adjusting unit provided between the light irradiation unit and the light source according to the detected surface condition Adjusting the strength of the.

  According to the medical treatment device and the method of using the device according to the present invention, the light intensity adjustment unit adjusts the intensity of the light output from the light source, so that fine adjustment can be easily performed. Only the affected part can be damaged, and side effects of treatment can be suppressed.

  In addition, since the light intensity can be adjusted according to the treatment status, treatment with higher accuracy can be performed, and side effects of treatment can be minimized.

  Next, a medical treatment apparatus according to the present invention and a method of using the apparatus will be described in detail with reference to the drawings. The medical treatment apparatus according to the present invention is used for PDT. Here, the PDT will be briefly described.

  PDT is a method for treating localized lesions such as cancer. In PDT, first, a photosensitive substance (PDT drug solution) is administered to a living body. After the PDT drug solution is accumulated in the lesioned part, light for activating the PDT drug solution is irradiated toward the lesioned part.

  As the light source for activating the PDT chemical solution, for example, light from a semiconductor laser, a dye laser, an optical parametric oscillator, or the like is used. At this time, the wavelength of light corresponding to the type of the PDT chemical is selected.

  When the PDT chemical solution is activated by light, oxygen around the PDT chemical solution is activated. The activated oxygen has strong oxidizing power as singlet oxygen. Due to the oxidizing power of singlet oxygen, cells or blood vessels in the lesion are damaged and the living body is treated.

  The PDT chemical solution refers to a photosensitive substance necessary for performing PDT, and this photosensitive substance has a property of being activated by light having a peak intensity within a predetermined range.

  Examples of PDT drugs include porphyrin-related compounds, such as photofrin, resaphyrin, visdyne, ATX-S10Na (II), ALA, and Lutex.

  The range of light intensity that the PDT drug activates varies according to the PDT drug to be introduced.

  The PDT drug solution has a property of accumulating in a lesion. However, the drug solution is also present at a lower concentration in the healthy area around the lesion than in the lesion. Therefore, if a predetermined range of intensity of light is irradiated on the healthy part around the lesioned part, the healthy part is damaged. Therefore, if there is a healthy part in the shallow part from the surface of the living body and there is a lesion part in the deep part, the strength is in a range that does not cause damage in the healthy part, and the intensity in the range that causes damage when reaching the lesion part. In addition, it is necessary to control the light intensity. This control enables selective treatment of only the lesion, prevents damage to the healthy part, and reduces the physical burden on the patient.

  The medical treatment apparatus described below can adjust the intensity of light mechanically according to the necessity as described above.

  FIG. 1 is a conceptual diagram of a medical treatment apparatus according to the present invention.

  As shown in FIG. 1, a medical treatment apparatus 100 according to the present invention includes a light source 102 that outputs light, a light irradiation unit 110 that emits light from the light source 102 toward a lesioned part 104, and a light source. The optical fiber 106 that connects the light source 102 and the light irradiation unit 110, and the light intensity on the living body surface 105 that is provided between the light source 102 and the light irradiation unit 110 and between the lesioned part 104 and the light irradiation unit 110. It is comprised from the light intensity adjustment part 120 to adjust. Various configurations of the light intensity adjusting unit 120 can be considered, and an example of the specific configuration will be described in detail later.

  Except for a part of the light source 102 and the optical fiber 106, the light irradiation unit 110 and the light intensity adjustment unit 120 are accommodated in the case 101.

  The light intensity adjusting unit 120 includes spot diameter adjusting means for adjusting the spot diameter of the light irradiated from the light irradiation unit 110 on the living body surface 105, and the spot diameter adjusting means is the case 101 as contact means that contacts the living body surface 105. An optical fiber moving means 130 for changing the distance L1 between the irradiation end 106A and the contact portion 122 by moving the translucent contact portion 122 provided on the outer surface of the optical fiber 106 and the irradiation end 106A of the optical fiber 106 in the vertical direction in the figure. And have. The contact portion 122 is formed by opening a light passage region in the case 101 and attaching a window formed of a material having excellent light transmission properties such as PET, PE, nylon, glass, and acrylic to the opening portion. Yes.

  FIG. 2 is a block diagram showing a configuration of an optical feedback system of the medical treatment apparatus 100 according to the present invention.

  A light intensity adjusting unit 120 is provided at the subsequent stage of the light source 102. Further, a light irradiation unit 110 is provided after the light intensity adjustment unit 120. A sensor 140 for detecting the surface condition of the living body is provided on the surface of the living body. A light intensity instruction unit 145 connected to the light intensity adjustment unit 120 is connected to the sensor 140. The light intensity instruction unit 145 instructs the light intensity adjustment unit 120 to adjust the light intensity according to the surface condition of the living body detected by the sensor 140.

  The sensor 140 is capable of observing fluorescence having a wavelength near 1270 nm. This is for the following reason.

  When the PDT chemical is activated, a peak is observed in the fluorescence spectrum near 1270 nm. This peak is known to be fluorescence emitted by singlet oxygen. Therefore, when performing PDT, the surface condition of a living body can be observed by observing the intensity of fluorescence having a wavelength of about 1270 nm. In addition, it can be judged that the PDT agent has been activated when a peak is observed in fluorescence having a wavelength of around 1270 nm.

  The sensor 140 must be able to detect fluorescence at this wavelength. Since the photomultiplier tube is an ultra-sensitive optical sensor that can amplify and detect the weak fluorescence received, it is a suitable sensor for detecting the fluorescence emitted from the PDT chemical liquid upon activation of the PDT chemical liquid. . Therefore, in this embodiment, the surface condition of the living body is detected by measuring light with a photomultiplier tube from a wavelength of 1220 nm to 1320 nm and detecting the intensity of fluorescence near 1270 nm.

  The sensor 140 may be a temperature sensor that can measure the temperature of the living body surface. Examples of such a temperature sensor include a thermistor, a resistance-side temperature body such as a fine metal wire, a thermocouple, or a non-contact infrared thermometer. When light is absorbed by the PDT chemical solution, part of the light energy absorbed by the chemical solution becomes heat and raises the living body temperature. When a living body is heated at, for example, 48 ° C. for 3 minutes, the living body suffers from irreversible protein denaturation. Therefore, when the temperature at which the living body is coagulated and denatured is detected by the temperature sensor, it can be determined that the PDT chemical is activated on the surface of the living body, which is a healthy part.

  The medical treatment apparatus 100 according to the present invention configured as described above generally operates as follows.

  The surgeon holds the case 101 and presses the contact portion 122 onto the lesioned portion 104. Then, light is output from the light source 102 such as a laser diode. Light from the light source 102 travels through the optical fiber 106 and is irradiated toward the lesion 104 from the irradiation end 106A. A sensor 140 provided on the living body surface 105 detects the surface condition of the living body. Since the administered PDT drug solution exists in and around the lesioned part 104, the drug solution is activated by light irradiation, and the lesioned part 104 is treated. When the sensor 140 detects an abnormality in the surface condition of the living body, the light intensity instruction unit 145 instructs the light intensity adjustment unit 120 to adjust the light intensity. In response to the instruction, the light intensity adjusting unit 120 changes the distance L1 between the irradiation end 106A of the optical fiber 106 and the contact unit 122 by the optical fiber moving unit 130.

  Note that the relationship between the distance L1 between the irradiation end 106A and the contact portion 122 and the light intensity on the living body surface 105 is such that the intensity decreases to about ¼ when the distance L1 is doubled.

  As described above, the light intensity on the surface of the living body is mechanically automatically adjusted based on the detection result of the sensor 130.

  In the above embodiment, light is directly irradiated from the irradiation end 106A of the optical fiber 106 toward the lesioned portion 104. However, an optical element such as a lens is interposed between the irradiation end 106A and the contact portion 122. Also good.

  3 does not directly irradiate light from the irradiation end 106A of the optical fiber 106 toward the lesion 104 as shown in FIG. 1, but changes the traveling direction of the light between the irradiation end 106A and the contact portion 122. It is a figure which shows the medical treatment apparatus which provided the means.

  As shown in FIG. 3, the medical treatment apparatus 100 according to this embodiment includes a light source 102 that outputs light, a light irradiation unit 110 that emits light from the light source 102 toward a lesioned part 104, and a light source 102. Is adjusted between the light source 102 and the light irradiation unit 110 and adjusts the light intensity on the living body surface 105 between the lesioned part 104 and the light irradiation unit 110. The light intensity adjusting unit 120 is configured to be configured.

  The light irradiation unit 110 is provided in a long catheter body 112 that is inserted into the lumen of a living body, functions as a means for changing the traveling direction of light, and changes the traveling direction of light by 45 degrees to perform side irradiation. And a translucent contact portion 122 provided on the outer surface of the catheter main body 112. The irradiation end side of the optical fiber 106 is movably held by a holding member 113.

  The light intensity adjustment unit 120 includes a holder 154, a base 156, a motor 158, and a ball screw 160. The holder 154 is movably attached on the base 156. The movement of the holder 154 is performed by a ball screw 160 attached to the motor 158. The holder 154, the motor 158, and the ball screw 160 function as an optical fiber moving unit that changes the distance between the irradiation end 106 </ b> A of the optical fiber and the contact portion 122 via the reflecting mirror 150. When the holder 154 moves, the irradiation end 106A of the optical fiber 106 moves by the amount of movement. By this movement, the spot diameter of the light reflected by the reflecting mirror 150 and applied to the lesioned part 104 changes. For example, when the irradiation end 106A is at the illustrated solid line position, the spot diameter L2 is irradiated toward the lesioned part 104, and when the irradiation end 106A is at the illustrated dotted line position, the spot is smaller than the spot diameter L2 toward the lesioned part 104. Light with a diameter L3 is irradiated. Therefore, the intensity of light on the living body surface 105 changes according to the amount of movement of the holder 154.

  In the above embodiment, the planar reflecting mirror 150 is exemplified as a means for changing the traveling direction of light, but a curved reflecting mirror may be used as a means for changing the traveling direction of light. Furthermore, an optical system that refracts light, such as a prism or a lens, can also be used.

  The optical fiber moving means may have a structure as shown in FIG. 4 or FIG. 5 in addition to the method using the ball screw shown in FIG.

  In the optical fiber moving means shown in FIG. 4, a spiral groove 172 is formed in a cylindrical tube 170, and the optical fiber 106 is fixed to a holder 174 having a protrusion that engages with the groove. The optical fiber moving means having this structure can move the optical fiber 106 forward and backward by rotating the cylindrical body 170 with a motor.

  The optical fiber moving means shown in FIG. 5 has an arm 182 fixed to a rotating body 180 and an optical fiber 106 fixed to a holder 184 movable with respect to the arm 182. The optical fiber moving means having this structure can move the optical fiber 106 forward and backward by rotating the rotating body 180 with a motor.

  In the above embodiment, the intensity of light is adjusted by moving the irradiation end 106 </ b> A of the optical fiber 106 forward and backward relative to the living body surface 105. In the following embodiment, the optical numerical aperture of light incident on the optical fiber 106 via the condenser lens is adjusted instead of mechanically moving the optical fiber 106.

  FIG. 6 is a diagram illustrating a specific configuration of the light intensity adjusting unit 120. The light intensity adjusting unit 120 condenses the light output from the laser diode and converts it into a predetermined spot diameter, and a fiber end holder 164 that holds the end of the optical fiber 106. And have. The condenser lens 161 located on the laser diode side is fixed on the base 165. The condenser lens 162 is mounted on the base 165 so as to be movable back and forth in the optical axis direction of light. The condenser lens 162 is moved by a ball screw 167 attached to the motor 166. On the other hand, the fiber end holder 164 is also mounted on the base 165 so as to be movable back and forth in the optical axis direction of light. The movement of the fiber end holder 164 is performed by a ball screw 169 attached to the motor 168.

  The condensing lenses 161 and 162, the fiber end holder 164, the motors 166 and 168, and the ball screws 167 and 169 function as spot diameter adjusting means, and the condensing lenses 161 and 162 change the incident angle of light to the optical fiber. The motor 166 and the ball screw 167 function as lens moving means for moving the lens forward and backward, and the motor 168 and the ball screw 169 function as optical fiber moving means for moving the optical fiber forward and backward relative to the lens.

  As a general characteristic of the optical fiber 106, as shown in FIG. 7, the incident NA of the optical fiber on the light source side (laser diode side) is reflected as it is on the emission NA on the irradiation side (light irradiation unit side). That is, when light is incident at an angle θ, the light is emitted at the angle θ. Therefore, in the light intensity adjusting unit 120, when the light from the laser diode is incident on the incident end of the optical fiber by changing the angle from the incident end of the optical fiber (in a conical shape), the light is incident at the incident angle. Since the light is emitted, the spot diameter of the light can be adjusted while the distance between the light irradiation unit and the living body is kept constant, and the intensity of the light irradiated to the lesioned part can be adjusted.

  Here, NA is referred to as an optical numerical aperture, and can be expressed as NA = n sin θ, where θ is the incident angle of light and n is the refractive index of the output medium. In the case of a living body, n is about 1.33 which is the same as the refractive index of water.

  The laser light incident as coaxial light from the laser diode is condensed by the condensing lens 161 having a focal length f1, and is incident on the condensing lens 162 with a constant NA (Φ0). The position of the condenser lens 162 is set by moving back and forth in the optical axis direction while maintaining the optical axis center by the motor 166 and the ball screw 167. The distance a from the incident side focal point to the condensing lens 162 can be changed by rotating the motor 166. The beam diameter D can be expressed as D = atan Φ0. In order for the laser light to enter the optical fiber 106, the focal length f2 of the condenser lens 162 needs to be longer than this distance a.

  The laser beam condensed by the condenser lens 162 forms an image at the position of the focus distance b. The laser beam is guided into the optical fiber 106 by setting the imaging position in the optical fiber. The position of the optical fiber 106 is moved by the motor 168 so that the light is properly guided. The distance b can be calculated by the lens formula 1 / f2 = 1 / a + 1 / b. The position of the optical fiber end that is most efficiently guided can be calculated from the core diameter of the optical fiber, the beam diameter on the condenser lens 162, and the value of b.

  Since the distance X is expressed by 1-d / D, if the position of the condenser lens 162 is determined, the position of the optical fiber end is uniquely determined. The motors 166 and 168 adjust the positions of the condensing lens 162 and the incident end of the optical fiber 106 so that these positions are realized.

  By using the light intensity adjusting unit 120 that operates as described above and adjusting the position of the condenser lens 162, the incident NA to the optical fiber end can be changed, and the exit NA is changed to irradiate the lesioned part. The intensity of the light to be adjusted can be adjusted.

  FIG. 8 is a diagram for explaining the influence of the relative position between the lens and the incident end of the optical fiber on the energy of light.

  For example, when the focal length of the condenser lens 161 is f1, the focal length of the condenser lens 162 is f2 = 50 mm, the optical fiber core diameter is 0.6 mm, and the NA on the light source side is 0.5, as shown in FIG. When the position of the condenser lens 162 is a = 10 mm, the incident beam diameter is 5 mm, the focus position is b = 12.5 mm, and the optical fiber incident end position is X = 11.8 mm. X + a = 21.8 mm, the optical fiber incident NA is 0.37, the beam diameter on the surface of the living body is 12.2 mm, and the irradiation energy density corresponding to the light intensity is 1.

  On the other hand, when the position of the condenser lens 162 is a = 25 mm, the incident beam diameter is 12.5 mm, the focus position is b = 50.0 mm, and the optical fiber incident end position is X = 48.8 mm. The optical fiber incident end position X + a = 73.8 mm, the optical fiber incident NA is 0.24, the beam diameter on the living body surface is 11.2 mm, and the irradiation energy density as the light intensity is 1.18.

  Further, when the position of the condenser lens 162 is a = 35 mm, the incident beam diameter is 17.5 mm, the focus position is b = 16.7 mm, and the optical fiber incident end position is X = 14.7 mm. The optical fiber incident end position X + a = 149.7 mm, the optical fiber incident NA is 0.15, the beam diameter on the surface of the living body is 10.8 mm, and the irradiation energy density as the light intensity is 1.27.

  As described above, the intensity of the light applied to the lesion can be adjusted between 1 and 1.27 simply by changing the relative position between the lens 162 and the fiber end holder 164. The light intensity instruction unit 145 calculates where the position of the lens 162 is set and where the fiber end holder 164 is set by a signal from the sensor 130 and gives an instruction to the light intensity adjustment unit 120. Therefore, in the light intensity instruction unit 145, as shown in FIG. 8, the position of the condensing lens 162, the position of the fiber end holder 144, and the light when the condensing lens 142 and the fiber end holder 164 are at the respective positions are displayed. It is necessary to store a table showing the relationship between the intensity and a table showing the relationship between the surface condition and the light intensity.

  By providing such a light intensity adjusting unit 120, the incident NA can be changed without moving the position of the optical fiber at the emission position, and the light intensity can be finely adjusted.

  The principle of detection of the surface condition by the sensor 140 is as described above, and an ultrasensitive optical sensor such as a photomultiplier tube is used as the sensor 140.

  FIG. 9 is a flowchart showing a procedure for using the medical treatment apparatus according to the present invention.

  First, the surgeon sets a treatment threshold in the light intensity instruction unit 145. The treatment threshold is the degree of activation of the PDT drug captured by the sensor 140 for determining whether or not the treatment of the lesion is completed, in other words, the intensity of fluorescence around 1270 nm (S11). ). Although not shown, the intensity of light output from the laser diode 102A is controlled by a control device. In the control apparatus, the peak intensity, frequency, total energy density, concentration of PDT chemical solution to be supplied to the living body, and treatment time are set as initial treatment conditions. These conditions are determined based on a situation obtained by examining a living body in advance, for example, the position and depth of a lesion.

  When the setting of the treatment threshold is completed, laser beam irradiation is started (S12). While the laser beam is irradiated, the sensor 140 detects the surface condition. As described above, the surface condition is detected based on the intensity of fluorescence around 1270 nm (S13). The light intensity instruction unit 132 determines whether or not the detected fluorescence intensity exceeds the treatment threshold set in S11 (S14). If the detected fluorescence intensity does not exceed the treatment threshold (S14: NO), the treatment is continued as it is. On the other hand, if the detected fluorescence intensity exceeds the treatment threshold (S14: YES), it is determined whether or not the treatment time has passed (S15). If the treatment time has elapsed (S15: YES), the irradiation of the laser beam from the laser diode 114A is stopped, and the irradiation is terminated (S17). On the other hand, if the treatment time has not elapsed (S15: NO), the light intensity instruction unit 132 instructs the light intensity adjustment unit 120 to decrease the intensity to a certain degree. Upon receiving this instruction, the light intensity adjusting unit 120 moves the condenser lens 162 shown in FIG. 6 and adjusts the spot diameter of the light irradiated toward the lesioned part, thereby irradiating light to the lesioned part. The density is lowered (S16).

  As described above, in the present embodiment, the light intensity on the living body surface of the light irradiated toward the lesion can be adjusted using a mechanism that can be mechanically adjusted, so that fine adjustment can be easily performed. This can be done, and only the lesion can be damaged, and the side effects of treatment can be suppressed.

  In the above embodiment, the urethra is exemplified as the lumen, but the present invention can also be applied to other lumens.

  According to the present invention, since the irradiation intensity of light can be adjusted so as not to damage the healthy part other than the lesioned part, it can be used particularly in the PDT treatment.

It is a conceptual diagram of the medical treatment apparatus which concerns on this invention. It is a block diagram which shows the structure of the optical feedback system of the medical treatment apparatus which concerns on this invention. It is a figure which shows the medical treatment apparatus which concerns on this Embodiment. FIG. 4 is a view showing another embodiment of the optical fiber moving means constituting the light intensity adjusting unit in the medical treatment apparatus of FIG. 3. FIG. 4 is a view showing another embodiment of the optical fiber moving means constituting the light intensity adjusting unit in the medical treatment apparatus of FIG. 3. It is a figure which shows other embodiment of a light intensity adjustment part. It is a figure where it uses for description of the relationship between incident NA and output NA. It is a figure for demonstrating the influence which the relative position of a lens and the incident end of an optical fiber has on the energy of light. It is a flowchart which shows the use procedure of the medical treatment apparatus which concerns on this invention.

Explanation of symbols

100 medical treatment device,
102 light source,
104 lesion,
105 biological surface,
106 optical fiber,
106A irradiation end,
108 PDT chemical injection part,
110 light irradiation part,
112 catheter body,
120 light intensity adjustment unit,
122 contact part 130 optical fiber moving means,
140 sensors,
145 light intensity indicator,
150 reflector,
161, 162 condenser lens,
164 Fiber end holder,
156, 165 base,
158, 166, 168 motors,
160, 167, 169 Ball screw.

Claims (9)

A medical treatment apparatus provided with a light irradiation means for irradiating light,
The light irradiation means includes
A light source that outputs light;
A light irradiator that irradiates light from the light source toward the lesion; and
An optical fiber connecting the light source and the light irradiation unit;
A light intensity adjustment unit that is provided between the light source and the light irradiation unit and adjusts the intensity of light on the surface of the living body between the lesioned part and the light irradiation unit;
A medical treatment device comprising: further,
A sensor for detecting the surface condition of the biological surface;
A light intensity instruction means for instructing the light intensity adjustment unit to adjust the intensity of the light according to the surface condition detected by the sensor;
The medical treatment device according to claim 1, comprising: The light intensity adjusting unit is
The medical treatment apparatus according to claim 1, further comprising spot diameter adjusting means for adjusting a spot diameter on the surface of the living body of light irradiated from the light irradiation unit. The spot diameter adjusting means includes
Contact means for contacting the biological surface;
An optical fiber moving means for changing a distance between an irradiation end of the optical fiber and the contact means;
The medical treatment device according to claim 3, comprising: The spot diameter adjusting means includes
The medical treatment apparatus according to claim 4, further comprising means for changing a traveling direction of the light between the contact means and the light irradiation end. The spot diameter adjusting means includes
The incident NA adjusting means includes an incident angle changing element that changes an incident angle of the light output from the light source to the optical fiber incident end, and the incident angle changing element and the optical fiber incident end. The medical treatment apparatus according to claim 3, wherein the incident NA is adjusted by adjusting the distance to the back and forth. A method of using the medical treatment device according to claim 1,
Irradiating light from the light irradiation part toward the lesioned part,
Detecting the surface condition of the biological surface;
Adjusting the intensity of light output from the light source in a light intensity adjusting unit provided between the light irradiation unit and the light source according to the detected surface condition;
A method of using a medical treatment device comprising:   The method for using the medical treatment device according to claim 7, wherein the step of detecting the surface condition of the surface of the living body is performed using a sensor.   The step of adjusting the intensity of light output from the light source is performed by adjusting a spot diameter on the surface of a living body of light irradiated from the light irradiation unit toward a lesioned part. A method for using the medical treatment device according to claim 7.

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