JP2013153951A - Laparoscope diagnostic apparatus and method for inspection for sentinel lymph node - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a laparoscope diagnostic apparatus capable of easily and rapidly predetermining the position of the sentinel lymph node and a method for inspecting the sentinel lymph node.SOLUTION: A laparoscope diagnostic apparatus 1 independently includes: a laparoscope 10 for imaging having a wave guide path for white illumination for irradiating an observation range P with white illumination light 3 and having a wave guide path for receiving reflective light 4 reflected at its observation range P and guiding it to an imaging part 90; and a laparoscope 20 for excitation having an excitation waveguide for radiating excitation light 5 excitating fluorescence material within the observation range P, and a light receiving waveguide receiving fluorescent light 6 emitted from a fluorescent substance present in the observation range P by means of the excitation light 5 and guiding the received fluorescent light 6 to fluorescent spectroscopy measurement 80, and in the laparoscope 10, a waveguide for white illumination is connected with a light source 50 for the white illumination, and the waveguide for imaging is connected with the imaging part 90, and the laparoscope 20 for excitation is connected with the light source 70 for excitation, and the light receiving waveguide is connected with the fluorescent spectroscopy measurement 80 to solve a problem.

Description

  The present invention relates to a laparoscopic diagnostic apparatus capable of easily and quickly specifying an accurate position of a sentinel lymph node and a method for inspecting a sentinel lymph node using the laparoscopic diagnostic apparatus.

  In general, in solid cancer surgery, a lesion is removed and a plurality of lymph nodes that are suspected of metastasis around the lesion are often removed (referred to as “lymph node cleansing”). Lymph node dissection is effective for the cure of cancer. However, for example, in the case of limited to early gastric cancer, the ratio of metastasis to lymph nodes is about 3 to 10%, and unnecessary lymph node cleansing has been performed for 90% or more patients who have not metastasized, There is a drawback that the burden on the patient is large.

  The lymph node to which the cancer cells that have entered the lymphatic vessels from the primary lesion of the cancer first arrive is called a sentinel-lymph-node, and whenever the cancer has spread to the lymph node, it is always sentinel lymph node. Is believed to have metastasis. Therefore, in early cancer surgery, the presence or absence of metastasis to lymph nodes can be determined by finding a sentinel lymph node, biopsying it, and conducting a rapid pathological examination. When the cancer has not spread to the sentinel lymph node, only the lesioned part is removed by laparoscopic surgery, or lymph node dissection is unnecessary. On the other hand, when cancer has metastasized to the sentinel lymph node, lymph node disinfection according to the metastatic state is required. For example, in the case of gastric cancer that has undergone lymph node metastasis, excision of the stomach ½ or more with lymph node dissection is required.

  These lymph nodes are outside the organ. Therefore, it cannot be detected with an endoscope whether there is cancer metastasis, and must be observed from outside the organ.

  In recent years, a fluorescent dye method for detecting a diseased tissue using a fluorescent dye has been proposed. For example, Patent Document 1 discloses that a photosensitive substance (cyanine dye) that emits fluorescence by excitation light is previously administered as a fluorescent diagnostic agent to a living body, irradiated with excitation light in the excitation wavelength band of the photosensitive substance, A method has been proposed in which fluorescence is generated from a fluorescent diagnostic agent accumulated in the light, and the generated fluorescence is received to detect the location of the lesion and the infiltration range. This method has also been proposed to be applicable to sentinel lymph nodes.

  Patent Document 2 proposes a detection system for easily and accurately detecting such sentinel lymph nodes from the surface of a living tissue. In this detection system, indocyanine green, which is a near-infrared fluorescent dye, is locally injected around the tumor in advance, laparotomy is performed after a predetermined time, and the observation part is irradiated with excitation light to emit indocyanine green. . Specifically, as shown in FIG. 2 of the same document, the observation unit is irradiated with near-infrared excitation light from the excitation light irradiation unit. Since indocyanine green is accumulated in the sentinel lymph node, near-infrared fluorescence is emitted, and the near-infrared fluorescence is multiplied by an image intensifier and converted into a visualized image by a fluorescent screen. An observer observes simultaneously the normal image which permeate | transmitted the half mirror, and the visualization image which reflected the mirror and the half mirror. Excitation light and fluorescence are light having a near infrared wavelength that is difficult to be absorbed by a living tissue such as fat covering the sentinel lymph node, so that the sentinel lymph node can be detected from the surface of the living tissue.

  Since laparotomy is a heavy burden on the patient, recently, for example, a non-laparotomy operation using a laparoscope as shown in Patent Document 3 has been performed. The laparoscope described in Patent Document 3 is used for diagnosis by inserting a laparoscope from a small hole opened in a patient and acquiring an image of the affected area. The laparoscope proposed in the same document has a distal end portion of a predetermined length to be inserted, and a mechanism for acquiring an image of the affected area and transmitting the acquired image of the affected area is provided at the distal end portion. . The image transmission mechanism is a long sheath tube formed of a rigid member, and is placed within the sheath tube to flow fluid across the outer surface of the image transmission means, from which it interferes with the image Means for removing objects.

  Patent Document 4 proposes using a bundle constituting an endoscope system as a laparoscope. The bundle used in the endoscope system described in this document has an excitation optical fiber in the center, and a plurality of light receiving optical fibers are arranged around it. The excitation optical fiber is connected to an excitation light source of the inspection control device, and the light receiving optical fiber is connected to a fluorescence detection detector. The endoscope system proposed in this document is formed so that the tip of the bundle is formed in a mortar shape, the center is recessed, and the portion from the center to the outside projects obliquely toward the tip of the bundle. Yes. This endoscope system is used in such a manner that the fluorescence received by the light receiving optical fiber is not leaked to the outside by abutting the tip of the bundle on the observation range.

WO98 / 48845 publication JP 2001-299676 A JP-A-6-22902 JP 2010-158358 A

  The technique proposed in Patent Document 2 is a laparoscope in which a laparoscope that emits excitation light and a laparoscope that emits white illumination light are the same. For this reason, it has been devised to irradiate excitation light and white illumination light alternately using a switching device so as not to be affected by the white illumination light during fluorescence spectroscopy measurement. When the same laparoscope is used, there is an advantage that the irradiation position of the excitation light and the irradiation position of the white illumination light coincide with each other. However, since the irradiation position and irradiation range cannot be changed by the excitation light and the white illumination light, when searching for the sentinel lymph node, the search range is limited to the irradiation range of the laparoscope, and the position of the sentinel lymph node is changed. There was a limit to searching accurately and quickly.

  In addition, since the technique proposed in Patent Document 2 cannot continuously measure a fluorescence image, it cannot measure in detail the temporal change in fluorescence intensity from the reagent injection, and can grasp the optimal detection time of the sentinel lymph node. Difficult, the efficiency and accuracy of detection have not been optimized, and both need to be improved. Further, since the excitation light and the white illumination light are simultaneously irradiated, there is a problem that noise in the fluorescence wavelength band due to the white illumination light is generated and the fluorescence sensitivity is deteriorated. In addition, the detection of sentinel lymph nodes was determined from the shape of the lymph and the relative luminance on the monitor, but the relative luminance depends on the time since administration of the fluorescent substance (test reagent) and injection, so it is appropriate It is necessary to select and judge an image of a long time, and there is a concern that a measurement error increases depending on the position of the sentinel lymph node.

  In addition, the technique proposed in Patent Document 3 can wash the laparoscope in order to prevent the laparoscope from being soiled and unable to pick up an image when taking the image with the laparoscope. Therefore, no means for detecting sentinel lymph nodes has been proposed.

  In addition, since the technique proposed in Patent Document 4 is used by abutting the tip of the laparoscope to the observation range, even if the abutted site is the position of the sentinel lymph node, the site is entirely It is extremely difficult to specify which area is located. In addition, no means for detecting sentinel lymph nodes has been proposed.

  The present invention has been made to solve the above-described problems, and an object of the present invention is to provide a laparoscopic diagnostic apparatus and a laparoscopic diagnostic apparatus that can easily and quickly specify the exact position of the sentinel lymph node. The object is to provide a method for examining sentinel lymph nodes.

A laparoscopic diagnostic apparatus according to a first aspect of the present invention for solving the above-mentioned problem is to receive a white illumination waveguide for irradiating an observation area with white illumination light and reflected light reflected from the observation area. An imaging laparoscope having an imaging waveguide guided to the imaging unit, an excitation waveguide that irradiates the observation area with excitation light that excites a fluorescent substance, and a fluorescent substance that exists in the observation area is excited. An excitation laparoscope having a light receiving waveguide for receiving fluorescence emitted by light and guiding the received fluorescence to a fluorescence spectroscopic measurement unit;
In the imaging laparoscope, the white illumination waveguide is connected to a white illumination light source, and the reflected light and the fluorescence received by the imaging waveguide are used as a color image (also referred to as a normal image) and a fluorescence image. The excitation laparoscope is connected to the imaging section for imaging, the excitation waveguide is connected to an excitation light source, and the light reception waveguide is connected to the fluorescence spectroscopy measurement section that measures the fluorescence received. It is characterized by.

  According to the present invention, the imaging laparoscope having the white illumination waveguide and the imaging waveguide and the excitation laparoscope having the excitation waveguide and the light receiving waveguide are independently provided. It is possible to change the irradiation position and irradiation range of the white illumination light irradiated from the irradiation position and the irradiation position and irradiation range of the excitation light irradiated from the excitation laparoscope. As a result, since the search range of the sentinel lymph node can be arbitrarily changed, the search with the excitation laparoscope can be performed in a wider range than the observation range of the imaging laparoscope. Further, since the white illumination light and the excitation light are emitted from independent laparoscopes, the generation of noise in the fluorescence wavelength band can be suppressed by cutting the excitation light wavelength band of the white illumination light. In addition, since the excitation light is irradiated by the excitation laparoscope to the observation range of the white illumination light irradiated by the imaging laparoscope, the color image (normal image) obtained from the reflected light and the fluorescence image obtained from the fluorescence are the same It can be acquired in a superimposed manner with an imaging laparoscope and sent to the imaging unit. As a result, it is possible to superimpose a color image and a fluorescence image in the observation range. In addition, the excitation laparoscope can receive the fluorescence simultaneously with the excitation light and send the received fluorescence to the fluorescence spectroscopy measurement unit. Fluorescence spectrum distribution at the part can be measured.

  The laparoscopic diagnostic apparatus according to the present invention is configured to have a monitor that displays a fluorescence spectrum measured by the fluorescence spectroscopy measuring unit.

  According to the present invention, since the monitor for displaying the fluorescence spectrum measured by the fluorescence spectrometer is provided, the fluorescence spectrum can be monitored in real time. As a result, the sentinel lymph node can be searched for while monitoring the fluorescence spectrum, and the exact position of the sentinel lymph node can be identified easily and quickly. This is because the detection sensitivity in the fluorescence spectrum is higher than the detection by the fluorescence image. Furthermore, when a fluorescent image is used, the sentinel lymph node is detected by visual judgment of the fluorescent image, but when a fluorescent spectrum is used, it can be detected by a spectral waveform peculiar to a fluorescent substance and a change in its intensity. This is because it is difficult to make individual differences in the judgment and measurement can be performed accurately.

  The laparoscopic diagnostic apparatus according to the present invention is configured such that in the imaging laparoscope, the white illumination waveguide is disposed at a position surrounding the imaging waveguide.

  According to the present invention, the reflected light of the white illumination light emitted from the white illumination waveguide and the fluorescence emitted from the excitation light emitted from the excitation waveguide by the fluorescent material are surrounded by the white illumination waveguide. Light can be efficiently received by the imaging waveguide. Further, by configuring each of the white illumination waveguide and the imaging waveguide with a plurality of optical fibers, a simple structure that is easy to manufacture becomes easy to manufacture.

  In the laparoscopic diagnostic apparatus according to the present invention, in the excitation laparoscope, the excitation optical waveguide is a single excitation optical fiber, and the light reception waveguide surrounds the excitation optical fiber. It is configured to be a fiber.

  According to the present invention, the fluorescent light emitted from the excitation light emitted from one excitation optical fiber is efficiently emitted by the plurality of light receiving optical fibers arranged so as to surround the excitation optical fiber. It can receive light. In addition, by arranging a plurality of light receiving optical fibers so as to surround the excitation optical fiber, a simple structure that is easy to manufacture becomes easy to manufacture.

  In the laparoscopic diagnostic apparatus according to the present invention, the light receiving waveguide is a plurality of light receiving optical fibers, and a part of the light receiving optical fiber is connected to the fluorescence spectroscopic measurement unit that measures a fluorescence spectrum, The light receiving optical fiber is connected to a fluorescence intensity measuring unit that measures the intensity of fluorescence, and the fluorescence spectrum and the fluorescence intensity are displayed on the monitor.

  According to the present invention, a part of the light receiving optical fiber is connected to the fluorescence spectroscopic measurement unit for measuring the fluorescence spectrum, and the remaining light receiving optical fiber is connected to the fluorescence intensity measuring unit for measuring the fluorescence intensity. Since the spectrum and the fluorescence intensity are displayed on the monitor, the fluorescence spectrum and the fluorescence intensity can be monitored simultaneously and in real time. Since the fluorescence spectrum and the image result obtained by superimposing the color image and the fluorescence image can be monitored simultaneously and in real time, the qualitative evaluation and quantitative evaluation of the fluorescent substance existing in the observation range can be performed. The position search can be performed easily and accurately. In addition, the monitor which displays a fluorescence spectrum and fluorescence intensity, and the monitor which displays the image result which superimposed the color image and the fluorescence image may be comprised by 1 unit | set, and may be comprised by multiple units | sets.

A laparoscopic diagnostic apparatus according to a second aspect of the present invention for solving the above-described problem is the position of a sentinel lymph node measured by measuring fluorescence emitted from a fluorescent substance using an imaging laparoscope and an excitation laparoscope. In the laparoscopic diagnostic device searching for
The excitation laparoscope has one excitation waveguide that irradiates excitation light that excites the fluorescent material, and a plurality of light guides fluorescence emitted from the fluorescent material to the fluorescence spectroscopic measurement unit by the excitation light irradiation. And a light receiving waveguide.
It has a monitor which superimposes and displays the fluorescence spectrum measured by the fluorescence spectroscopic measurement part in time series.

  According to this invention, the excitation laparoscope is guided to the fluorescence spectroscopic measurement unit by one excitation waveguide that irradiates the excitation light that excites the fluorescent substance, and the fluorescence that is emitted by the fluorescent substance by the irradiation of the excitation light. Since the plurality of light receiving waveguides are configured, the fluorescence emitted by the excitation light emitted from one excitation waveguide can be efficiently received by the plurality of light receiving optical fibers. In addition, since it has a monitor for displaying the fluorescence spectrum measured by the fluorescence spectrometer and searching for a place where the peak intensity of the displayed fluorescence spectrum is equal to or greater than a threshold value, the fluorescence spectrum and the fluorescence intensity can be simultaneously and It can be monitored in real time. Such monitoring can simultaneously perform qualitative evaluation and quantitative evaluation of the fluorescent substance existing in the observation range, and can easily and accurately search the position of the sentinel lymph node.

  In the laparoscopic diagnostic apparatus according to the present invention, a part of the plurality of light receiving waveguides is connected to the fluorescence spectroscopic measurement unit, and the remaining light receiving waveguides are connected to the plurality of fluorescence intensity measuring units for measuring the fluorescence intensity. The monitor is connected and displays a plurality of pieces of fluorescence intensity information measured by the plurality of fluorescence intensity measuring units, and is obtained by guiding the excitation laparoscope and the imaging laparoscope in the direction of strong fluorescence intensity. The displayed image information is configured to be displayed.

  According to the present invention, a part of the plurality of light receiving waveguides can be connected to the fluorescence spectroscopic measurement unit to obtain the above-described fluorescence spectrum, and the remaining light receiving waveguides can be used to measure the fluorescence intensity. The fluorescence intensity described above can be obtained by connecting to an intensity measuring unit. In addition, the monitor displays the fluorescence intensity information measured by multiple fluorescence intensity measurement units, and displays the image information (navigation display) that guides the imaging laparoscope in the direction of strong fluorescence intensity, so only the fluorescence spectrum is displayed. However, the search time can be shortened, but in addition, the measurement result in the fluorescence intensity measurement unit is displayed, and based on the result, the imaging laparoscope is guided in the direction where the fluorescent substance seems to exist more. Further, the search time for the position of the sentinel lymph node can be further shortened.

In order to solve the above problems, the sentinel lymph node inspection method according to the present invention irradiates the observation area with white illumination light, receives reflected light reflected in the observation area, and guides it to the imaging section. A laparoscope, an excitation laparoscope that irradiates the observation range with excitation light that excites a fluorescent substance, receives fluorescence emitted from the fluorescent substance present in the observation range, and guides the fluorescence to a fluorescence spectroscopic measurement unit; A method for examining sentinel lymph nodes using a laparoscopic diagnostic device independently comprising:
The image information obtained by imaging the optical signal received by the imaging laparoscope and the fluorescence analysis result obtained by analyzing the optical signal received by the excitation laparoscope by the fluorescence analysis means are acquired simultaneously and in time series. The time-series change of the fluorescence analysis result is measured, and the measurement result is displayed on a monitor and used as sentinel lymph node examination information.

  According to the present invention, a laparoscopic diagnostic apparatus including an imaging laparoscope having a white illumination waveguide and an imaging waveguide and an excitation laparoscope independently having an excitation waveguide and a light receiving waveguide is used. Therefore, the irradiation position and irradiation range of the white illumination light irradiated from the imaging laparoscope and the irradiation position and irradiation range of the excitation light irradiated from the excitation laparoscope can be changed. As a result, since the search range of the sentinel lymph node can be arbitrarily changed, the search with the excitation laparoscope can be performed in a wider range than the observation range of the imaging laparoscope. Further, since the white illumination light and the excitation light are emitted from independent laparoscopes, the generation of noise in the fluorescence wavelength band can be suppressed by cutting the excitation light wavelength band of the white illumination light. In addition, since the excitation light is emitted from the excitation laparoscope toward the observation target of the imaging laparoscope, the color image (normal image) obtained from the reflected light of the white illumination light and the fluorescence obtained from the fluorescence emitted from the fluorescent material The image can be acquired in a superimposed manner using the same imaging laparoscope and sent to the imaging unit. Also, the image information obtained by imaging the optical signal (reflected light and fluorescence) received by the imaging laparoscope and the fluorescence analysis result obtained by imaging the fluorescence received by the excitation laparoscope as a fluorescence spectrum at the same time Since it is possible to obtain the sentinel lymph node examination information by measuring the time-series change of the fluorescence image, it is possible to acquire the superimposed image by the color image of the observation range and the fluorescence image, and the fluorescence spectrum at the same time. Can be displayed on the monitor. As a result, the position of the sentinel lymph node can be searched accurately and quickly.

  In the inspection method for sentinel lymph nodes according to the present invention, the fluorescent material for visualizing the sentinel lymph nodes is injected or administered into a region to be inspected, and is included in a region including the observation range, and fluorescence emitted from the fluorescent material is emitted. It is configured to receive light and identify the position of the sentinel lymph node.

  According to the present invention, a fluorescent substance for visualizing a sentinel lymph node is injected or administered into a region to be examined, included in an area including an observation range, and the fluorescence emitted from the fluorescent substance is received and sentinel around a lesioned part is received. Since the position of the lymph node is specified, the specification can be performed more accurately and quickly. As a result, the position of the sentinel lymph node can be accurately identified, and the presence or absence of cancer metastasis can be diagnosed by removing the identified sentinel lymph node and performing pathological examination.

  In the sentinel lymph node examination method according to the present invention, the fluorescence analysis means is a fluorescence spectrometer and a fluorescence intensity meter, and the monitor is a time-series change of a fluorescence spectrum measured by the fluorescence spectrometer. The information on the fluorescence intensity measured by the fluorescence intensity measurement unit is displayed, and the excitation laparoscope and the imaging laparoscope are guided in a direction in which the fluorescence intensity is strong.

  According to the laparoscopic diagnostic apparatus and the sentinel lymph node inspection method using the laparoscopic diagnostic apparatus according to the present invention, the irradiation position and irradiation range of the white illumination light irradiated from the imaging laparoscope, and the excitation laparoscope The irradiation position and the irradiation range of the excitation light irradiated from can be changed, and the search range of the sentinel lymph node can be arbitrarily changed. Since the search by the laparoscope for excitation can be performed in a wider range than the observation range of the imaging laparoscope, the position search of the sentinel lymph node can be quickly performed. Further, since the white illumination light and the excitation light are emitted from independent laparoscopes, the generation of noise in the fluorescence wavelength band can be suppressed by cutting the excitation light wavelength band of the white illumination light. In addition, since the excitation light is emitted from the excitation laparoscope toward the observation target of the white illumination light irradiated by the imaging laparoscope, it is obtained from the color image obtained from the reflected light of the white illumination light and the fluorescence emitted from the fluorescent material. The fluorescence image to be obtained can be acquired in a superimposed manner by the same imaging laparoscope and sent to the imaging unit. As a result, the color image in the observation range and the fluorescence image can be superimposed and displayed on the monitor. Further, the image acquisition and the fluorescence spectrum acquired by the fluorescence spectroscopic measurement unit can be acquired simultaneously and displayed on the monitor.

It is a typical lineblock diagram of a laparoscopic diagnostic device concerning one embodiment of the present invention. It is a typical sectional view showing an example of an imaging laparoscope. It is typical sectional drawing which shows an example of the laparoscope for excitation. It is a typical block diagram which shows an example of the laparoscope for imaging, and various control apparatuses. It is a typical block diagram which shows an example of the laparoscope for excitation, and various control apparatuses. It is a front view of the connector which connects the waveguide for light reception to a spectrometer. It is typical explanatory drawing which shows the example which displayed the image information obtained in the observation range on the monitor. (A) is a schematic graph showing the result of the fluorescence spectrum obtained by moving the excitation laparoscope and searching for a place with high fluorescence intensity, and (B) shows the result obtained in (A). It is a typical graph which shows the relationship with the time of the fluorescence intensity plotted based on. It is a typical block diagram which shows another example of the laparoscope for excitation, and various control apparatuses. Schematic cross-sectional view showing another example of a laparoscope for excitation, cross-sectional view showing an example of a waveguide guided to a fluorescence intensity measurement unit, and cross-sectional view showing an example of a waveguide guided to a fluorescence spectroscopic measurement unit It is. It is a typical block diagram which shows another example of the laparoscope for excitation, and various control apparatuses. An example of a search method using both the fluorescence intensity measurement result obtained by searching the sentinel lymph node by moving the excitation laparoscope and the fluorescence intensity measurement result obtained when simultaneously measuring with a plurality of fluorescence intensity measuring instruments It is a typical graph which shows. In addition to the search method using both the fluorescence intensity measurement results obtained by searching the sentinel lymph node by moving the excitation laparoscope and the fluorescence intensity measurement results when simultaneously measuring with multiple fluorescence intensity measuring instruments It is a typical graph which shows an example. It is typical sectional drawing explaining the positional relationship of the optical fiber for light reception which comprises the laparoscope for excitation.

  DESCRIPTION OF EXEMPLARY EMBODIMENTS A laparoscopic diagnostic apparatus according to the present invention and a sentinel lymph node inspection method using the laparoscopic diagnostic apparatus will be described with reference to the drawings. The technical scope of the present invention is not limited only to the following description and drawings.

[Laparoscopic diagnostic equipment]
A laparoscopic diagnosis apparatus 1 according to the present invention is an apparatus for searching for sentinel lymph nodes by measuring fluorescence by a fluorescent substance and specifying the position of the sentinel lymph nodes. As shown in FIG. The mirror 10 and the exciting laparoscope 20 are provided independently of each other. The imaging laparoscope 10 receives the white illumination waveguide 17 that irradiates the observation range P with the white illumination light 3, and the imaging guide that receives the reflected light 4 reflected by the observation range P and guides it to the imaging unit 90. And a waveguide 16. In addition, the excitation laparoscope 20 receives and receives the excitation waveguide 26 that irradiates the observation range P with the excitation light 5 that excites the fluorescent substance, and the fluorescence 6 emitted from the fluorescent substance that exists in the observation range P. The light receiving waveguide 27 guides the fluorescence 6 to the fluorescence spectroscopic measurement unit 80.

  Furthermore, the white illumination waveguide 17 constituting the imaging laparoscope 10 is connected to a white illumination light source 50, and the imaging waveguide 16 uses the reflected light 4 as a color image (also referred to as a normal image) and a fluorescence image. It is connected to an imaging unit 90 that images. The excitation waveguide 26 constituting the excitation laparoscope 20 is connected to an excitation light source 70, and the light receiving waveguide 27 is connected to a fluorescence spectroscopic measurement unit 80 that spectroscopically measures the fluorescence 6. The laparoscopic diagnosis apparatus 1 according to the present invention can easily and quickly specify the exact position of the sentinel lymph node by providing such a configuration.

  As shown in FIG. 1, the entire configuration of the laparoscopic diagnostic apparatus 1 includes an imaging laparoscope 10, a white illumination light source 50 that makes the white illumination light 3 enter the white illumination waveguide 17 of the imaging laparoscope 10, and And an imaging unit 90 that acquires and reflects the reflected light 4 received by the imaging laparoscope 10. Further, the excitation laparoscope 20, the excitation light source 70 that makes the excitation light 5 incident on the excitation waveguide 26 of the excitation laparoscope 20, and the fluorescence spectroscopic measurement that spectrally analyzes the fluorescence 6 received by the excitation waveguide 26. Part 80. Furthermore, it has the control apparatus 100 for performing various control, the monitor 200 which displays the color image and fluorescence image of the observation range P, and the monitor 200 which displays the result measured by the fluorescence spectroscopy measurement part 80.

  Among these, the control device 100 includes an image processing unit 110 that processes a color image and a fluorescence image, and performs various image processing based on the reflected light 4 and the fluorescence 6 guided by the imaging laparoscope 10. ing. Further, the control device 100 is provided with a timing control unit 150, which is connected to the white illumination light source 50 and the excitation light source 70, and irradiates the white illumination light 3 and the excitation light 5. The timing is controlled.

  The timing control unit 150 causes the monitor 200 to display a color image obtained by receiving the reflected light 4 of the white illumination light 3 and a fluorescence image obtained by receiving the fluorescence 6 emitted from the fluorescent material by the excitation light 5. . The monitor 200 can display a color image and a fluorescent image independently or in superposition according to a command from the timing control unit 150. One monitor or two or more monitors may be used. Further, each image can be stored in a recording device (not shown), and one or both of the stored normal image and fluorescent image can be displayed on the monitor 200.

  Furthermore, the control device 100 includes a measurement result display control unit 160 that performs control to display the spectroscopic measurement result by the fluorescence spectroscopic measurement unit 80 on the monitor 200. The fluorescence spectroscopic measurement unit 80 measures the fluorescence spectrum of the fluorescence 6 emitted from the fluorescent material excited by the irradiation of the excitation light 5.

  Hereinafter, the configuration of the laparoscopic diagnostic apparatus according to the present invention will be described in detail.

<Laparoscope for imaging>
As shown in FIGS. 1 and 2, the imaging laparoscope 10 includes a white illumination waveguide 17 that guides the white illumination light 3 and irradiates the observation range P with the white illumination light 3, and the observation range P. And an imaging waveguide 16 that receives the reflected light 4 reflected by the laser beam and guides the reflected light 4 to the imaging unit 90. As shown in FIG. 1, the imaging waveguide 16 is used by introducing carbon dioxide into the abdomen from an insertion port H formed in a patient and inflating it in advance, and inserting the tip side inward.

  As shown in FIG. 1, the imaging laparoscope 10 includes a holder 11 for mounting the imaging laparoscope 10 on a patient, and an elongated cylindrical sheath tube 12 whose outer periphery is held by the holder 11. Yes. A white illumination waveguide 17 and an imaging waveguide 16 are inserted into the sheath tube 12.

(holder)
The holder 11 is a member formed in a cylindrical shape or a substantially cylindrical shape, and acts to hold the imaging laparoscope 10 in the insertion port H by being inserted inside the insertion port H formed in the outer skin of the patient. . A penetrating portion extending in the axial direction is formed at the center of the holder 11, and the sheath tube 12 is inserted into the penetrating portion and held by the holder 11.

(Sheath tube)
The sheath tube 12 is formed of a member having a certain rigidity and strength so that the white illumination waveguide 17 and the imaging waveguide 16 inserted therein can be fixed in position. The tips of the white illumination waveguide 17 and the imaging waveguide 16 inserted in the sheath tube 12 are aligned with the tips of the sheath tube 12. In addition, a transparent sealing portion 13 that seals the tip of the sheath tube 12 is provided at the tip of the sheath tube 12. The transparent sealing portion 13 is formed of a transparent member such as glass, and can irradiate the white illumination light 3 emitted from the tip of the white illumination waveguide 17 toward the observation range P. . Note that a lens 15 can be provided between the end face of the imaging waveguide 16 and the transparent sealing portion 13 as necessary, and the viewing field range P and the focal position can be adjusted.

(White illumination waveguide)
The white illumination waveguide 17 is connected to the white illumination light source 50, guides the white illumination light 3 emitted from the white illumination light source 50, and irradiates the observation range P. As shown in FIG. 2, the white illumination waveguide 17 includes a plurality of optical fibers (17,..., 17) arranged so as to surround the imaging waveguide 16. By arranging in this way, as shown in FIG. 1, the reflected light 4 of the white illumination light 3 emitted from the white illumination waveguide 17 and the excitation light 5 emitted from the excitation waveguide 16 described later are provided. The fluorescence 6 emitted from the fluorescent material can be efficiently received by the imaging waveguide 16 surrounded by the white illumination waveguide 17. Note that, from the imaging laparoscope 10 to the white illumination light source 50, as shown in FIG. 4 to be described later, a white illumination cable 17a having a structure in which the white illumination waveguide 17 is covered with a protective layer, for example. The white illumination waveguide 17 is protected and at the same time flexible.

(Imaging waveguide)
The imaging waveguide 16 is connected to the imaging unit 90 and guides the reflected light 5 and the fluorescence 6 received at the tip to the imaging unit 90 that captures a color image and a fluorescence image. As shown in FIG. 2, the imaging waveguide 16 is an optical fiber bundle in which a plurality of optical fibers are bundled. The imaging waveguide 16 is arranged at the center of the imaging laparoscope 10 and is provided with a white illumination waveguide 17 around it. It has been. Note that, from the imaging laparoscope 10 to the imaging unit 90, as shown in FIG. 4 described later, an imaging cable 18 having a structure in which the imaging waveguide 16 is covered with a protective layer, for example, is white. The illumination waveguide 17 is protected and at the same time flexible.

<Laparoscope for excitation>
As shown in FIGS. 1 and 3, the excitation laparoscope 20 excites the excitation waveguide 26 that irradiates the observation range P with excitation light 5 that excites the fluorescent substance, and the fluorescent substance that exists in the observation range P is excited. It has a light receiving waveguide 27 that receives the fluorescence 6 emitted by the light 5 and guides the received fluorescence 6 to the fluorescence spectroscopic measurement unit 80. The excitation laparoscope 20 has an excitation waveguide 26 connected to an excitation light source 70 and a light reception waveguide 27 connected to a fluorescence spectroscopic measurement unit 80 that measures fluorescence 6 received. As shown in FIG. 1, the excitation laparoscope 20 is inflated by introducing carbon dioxide into the abdomen in advance from the insertion opening H formed in the patient, as shown in FIG. It is used by inserting toward the inside.

  As shown in FIG. 1, the excitation laparoscope 20 also includes a holder 21 for mounting the excitation laparoscope 20 on a patient, and an elongated cylindrical sheath tube 22 whose outer periphery is held by the holder 21. Yes. Inside the sheath tube 22, an excitation waveguide 26 and a light reception waveguide 27 are inserted.

(holder)
The holder 21 is a member formed in a cylindrical shape or a substantially cylindrical shape, and acts to hold the excitation laparoscope 20 in the insertion port H by being inserted inside the insertion port H formed in the outer skin of the patient. . A penetrating portion extending in the axial direction is formed at the center of the holder 21, and the sheath tube 22 is inserted into the penetrating portion and held by the holder 21.

(Sheath tube)
The sheath tube 22 is formed of a member having a certain rigidity and strength so that the position of the excitation waveguide 26 and the light receiving waveguide 27 inserted therein can be fixed. End portions of the excitation waveguide 26 and the light reception waveguide 27 inserted into the sheath tube 22 are aligned with the distal end of the sheath tube 22. In addition, a transparent sealing portion 23 that seals the distal end of the sheath tube 22 is provided at the distal end of the sheath tube 22. The transparent sealing portion 23 is made of a transparent member such as glass, and can emit the excitation light 5 emitted from the tip of the excitation waveguide 26 toward the observation range P. A lens (not shown) may be provided between the end face of the excitation waveguide 26 and the transparent sealing portion 23 as necessary, and the range in which the excitation light is irradiated can be adjusted.

(Excitation waveguide)
The excitation waveguide 26 is connected to the excitation light source 70, guides the excitation light 5 emitted from the excitation light source 70, and irradiates the observation range P. As shown in FIG. 3, in the excitation waveguide 26, one excitation optical fiber is disposed at the center or substantially the center of the excitation laparoscope 20, and a light receiving waveguide 27 is provided therearound. . The pumping waveguide 2 may be composed of a plurality of pumping optical fibers. By arranging in this way, as shown in FIG. 3, the fluorescence 6 emitted from the fluorescent material by the excitation light 5 irradiated from the excitation waveguide 26 is received around the excitation waveguide 26. The light guide 27 can efficiently receive light. Between the excitation laparoscope 20 and the excitation light source 70, as shown in FIG. 5 described later, an excitation cable 26 ′ having a structure in which the excitation waveguide 26 is covered with a protective layer, for example, is provided. The waveguide 26 is protected and at the same time has flexibility.

(Light receiving waveguide)
The light receiving waveguide 27 is connected to the fluorescence spectroscopy measuring unit 80 and guides the fluorescence 6 received at the tip to the fluorescence spectroscopy measuring unit 80. As shown in FIG. 3, the light receiving waveguide 27 is composed of a plurality of light receiving optical fibers, and is arranged so as to surround the excitation waveguide 26. As shown in FIG. 5, a light receiving cable 27 ′ having a structure in which the light receiving waveguide 27 is covered with, for example, a protective layer is provided between the excitation laparoscope 20 and the fluorescence spectroscopic measuring unit 80. The waveguide 27 is protected and at the same time flexible.

  The excitation laparoscope 20 configured in this way, for example, emits the fluorescence 6 emitted from the fluorescent material by the excitation light 5 irradiated from one excitation optical fiber (excitation waveguide 26). Light can be efficiently received by a plurality of light receiving optical fibers (light receiving waveguides 27) arranged so as to surround the excitation waveguide 26). Further, by arranging a plurality of light receiving optical fibers (light receiving waveguides 27) so as to surround the pumping optical fiber (pumping waveguide 26), a simple structure that is easy to manufacture becomes easy to manufacture. . In addition, as the optical fiber for excitation light, for example, an optical fiber having an outer diameter of 0.1 to 3 mm, preferably 0.5 to 2 mm can be used. Further, as the light receiving optical fiber, for example, an optical fiber having an outer diameter of 0.05 to 2 mm, preferably 0.1 to 1 mm can be used. The outer diameter of the bundle of the plurality of optical fibers for receiving light is arbitrary depending on the size of the laparoscope for excitation 20, but can be in the range of, for example, 6 to 12 mm, and preferably in the range of 8 to 10 mm. Is preferred.

  As the optical fiber used for the light receiving optical fiber, an optical fiber selected from a quartz fiber, a multicomponent glass fiber, a plastic optical fiber, and the like can be used. When using a relatively thick optical fiber, it is preferable to use a plastic optical fiber in consideration of flexibility. Such an optical fiber is not limited to a light receiving optical fiber, but can be applied to any of an imaging optical fiber, a white illumination optical fiber, and a pumping optical fiber.

  As shown in FIG. 5, the excitation laparoscope 20 includes an excitation optical fiber (excitation waveguide 26) and a light reception optical fiber (light reception waveguide 27) on the rear end side of the sheath tube 22. A branching portion 29 that branches is provided. The pumping optical fiber (pumping waveguide 26) branched from the branching section 29 is connected to the pumping light source 70. On the other hand, the branched light receiving optical fiber (light receiving waveguide 27) is connected to a fluorescence spectroscopic measurement unit 80 for analyzing the fluorescence guided by the light receiving optical fiber (light receiving waveguide 27). Further, on the front end side and the rear end side of the sheath tube 22, there are provided restraining means (fastening portions) for preventing a plurality of light receiving optical fibers as shown in FIG.

<Device configuration connected to imaging laparoscope>
FIG. 4 is a diagram illustrating an example of the device configuration of the imaging laparoscope 10 and various control devices connected to the imaging laparoscope 10.

(Laparoscope for imaging)
As shown in FIGS. 2 and 4, the imaging laparoscope 10 includes an imaging waveguide 16 (hereinafter also referred to as a fiber bundle 16) in which a plurality of optical fibers are bundled by a restraining means 19 inside a sheath tube 12. ) Is inserted. The sheath tube 12 is formed of an elongated member having a certain rigidity and strength so that the fiber bundle 16 inserted therein can be fixed in position. The tip of the fiber bundle 16 inserted into the sheath tube 12 is aligned with the tip of the sheath tube 12. At the distal end of the sheath tube 12, a transparent sealing portion 13 that seals the distal end is provided. The transparent sealing portion 13 is also formed of a transparent member, and is configured to transmit the emitted white illumination light 3 and the incident reflected light 4 and fluorescence 6. As described above, a lens 15 may be provided between the end face of the imaging waveguide 16 and the transparent sealing portion 13 as necessary, and the viewing field range P and the focal position can be arbitrarily adjusted.

  The fiber bundle 16 is a bundle of a plurality of optical fibers. The front and rear ends of the fiber bundle 16 are polished so that no optical loss occurs. Each optical fiber constituting the fiber bundle 16 is an optical fiber having an outer diameter of 0.01 to 2 mm. The fiber bundle 16 is formed by bundling such optical fibers and having an outer diameter of about 5 to 12 mm according to the size of the imaging laparoscope 10.

  The fiber bundle 16 is between the rear end of the sheath tube 12 constituting the imaging laparoscope 10 and the imaging section 90. The fiber bundle 16 is resin-coated so that it can be bent or the imaging cable 18 protected with a tube. And connected to the imaging unit 90.

(Imaging part)
As shown in FIG. 4, the imaging unit 90 images a housing 91 that forms an outer shell, a dichroic mirror 92 that is a light separation mechanism provided inside the housing 91, and the reflected light 4 that is separated by the dichroic mirror 92. And a CCD camera 94 for imaging the fluorescence 6 emitted from the fluorescent material by irradiation of the excitation light 5. The dichroic mirror 92 that is a light separation mechanism is disposed obliquely with respect to the traveling direction of the reflected light 4 and the fluorescence 6 received by the imaging laparoscope 10. The dichroic mirror 92 transmits the reflected light 4 as it is, and selectively reflects the fluorescent light 6 and the reflected light of the excitation light 5.

  The CCD camera 93 that images the reflected light 4 is provided on the rear side of the dichroic mirror 92 at a position on a straight line connecting the rear end 18a of the imaging cable 18 extending from the imaging laparoscope 10 and the center of the dichroic mirror 92. The lens is set facing the dichroic mirror 92. On the other hand, the CCD camera 94 that images the fluorescent light 6 is provided on the side of the dichroic mirror 92, and is set with the lens facing the dichroic mirror 92. The imaging unit 90 is provided with an excitation light cut filter 95 between the CCD camera 94 and the dichroic mirror 92 so that the excitation light is cut and only the fluorescence 6 is taken into the CCD camera 94. Both the CCD camera 93 and the CCD camera 94 are connected to the image processing unit 110.

  In the imaging unit 90, when the reflected light 4 is guided from the imaging laparoscope 10, the guided reflected light 4 passes through the dichroic mirror 92 and is guided to the CCD camera 93. The CCD camera 93 images the guided reflected light 4, and the captured image is supplied to the image processing unit 110.

  On the other hand, when the fluorescence 6 is guided from the imaging laparoscope 10, the guided fluorescence 6 is reflected by the dichroic mirror 92. The fluorescent light 6 is reflected in a direction substantially perpendicular to the traveling direction entering the dichroic mirror 92 and guided to the CCD camera 94. When the fluorescence 6 is imaged by the CCD camera 94, the excitation light is cut by the excitation light cut filter 95 provided in front of the lens, and only the fluorescence 6 from the fluorescent material is guided to the CCD camera 94. The CCD camera 94 images the guided fluorescence 6 and supplies the captured fluorescence image information to the fluorescence image processing unit 120 of the image processing unit 110.

(White illumination light source)
The white illumination light source 50 is a light source that emits the white illumination light 3. For example, a light source that emits white light such as a halogen lamp, a mercury lamp, or a white LED, or a light source that emits visible light can be used. FIG. 4 is an example of a white illumination light source including a lamp 51, an electrode 52, a reflection mirror 53, and a near infrared cut filter 54. Such a white illumination light source 50 is connected to the timing control unit 150, and the timing of turning on and off is controlled. The near-infrared cut filter 54 uses a filter that cuts a longer wavelength than the near-infrared light that excites the fluorescent material. As the white illumination light source 50, it is preferable to use a light source that does not emit light in the fluorescent wavelength band.

(Image processing unit)
As shown in FIG. 4, the image processing unit 110 irradiates the normal image processing unit 120 for obtaining a color image based on the reflected light 4 obtained by irradiating the white illumination light 3 and the excitation light 5. A fluorescence image processing unit 130 for obtaining a fluorescence image based on the obtained fluorescence 6. Further, the image processing unit 110 controls the ON / OFF timings of the superimposed image processing unit 140 that superimposes the processed color image and the fluorescent image, and the on / off driver of the white illumination light source 50 and the excitation light source 70. And a timing control unit 150. A monitor 200 is connected to the image processing unit 110, and the processed image is displayed on the monitor 200. A recording device (not shown) is provided to record the captured image and the image after image processing on the recording device.

  The normal image processing unit 120 is connected to a CCD camera 93 provided in the housing 91 of the image capturing unit 90, and performs normal image processing (color image processing) by capturing the reflected light 4 captured by the CCD camera 93. On the other hand, the fluorescence image processing unit 130 is connected to a CCD camera 94 provided in the housing 91 of the imaging unit 90, and performs fluorescence image processing by capturing the fluorescence 6 captured by the CCD camera 94. Further, it is possible to perform a process of displaying on the monitor 200 using an image recorded in the recording apparatus.

  The superimposed image processing unit 140 alternatively selects the color image and the fluorescent image based on the color image signal transmitted from the normal image processing unit 120 and the fluorescent image signal transmitted from the fluorescent image processing unit 130. Alternatively, a process of displaying the color image and the fluorescence image on the monitor 200 in a superimposed manner is performed. The superimposed image processing unit 140 is connected to the timing control unit 150 directly or via the normal image processing unit 120 and the fluorescence image processing unit 130. Therefore, selection of an image to be displayed on the monitor 200 is related to the irradiation timing of the white illumination light 3 and the excitation light 5.

  For example, when the white illumination light source 50 and the excitation light source 70 are controlled to irradiate only the white illumination light 3 to the observation range P, the light obtained by the illumination of the white illumination light 3 is displayed on the monitor 200. A color image obtained by processing (reflected light 4) is displayed. Further, when the white illumination light source 50 and the excitation light source 70 are controlled so as to irradiate only the excitation light 5 to a predetermined part of the observation range P, the monitor 200 processed the fluorescence 6 emitted from the fluorescent material. A fluorescent image is displayed. On the other hand, when the white illumination light source 50 and the excitation light source 70 are controlled so that both the white illumination light 3 and the excitation light 5 are irradiated, the color image and the fluorescence image are superimposed on the monitor 200. indicate.

  In the examination of the sentinel lymph node, when the white illumination light 3 and the excitation light 5 are alternately irradiated, even if one light source is intermittently irradiated, the color image and the fluorescence image are superimposed. This makes it easy to detect sentinel lymph nodes.

  In addition, the display of an image can select arbitrarily a color image, a fluorescence image, and those superimposed images. When the fluorescence spectrum measuring unit 80 measures the fluorescence spectrum, since the amount of the fluorescent material is very small, the reflected light 4 based on the white illumination light 3 becomes noise. Is preferably detected. The laparoscopic diagnosis apparatus 1 includes an automatic mode in which an image to be displayed on the monitor 200 is automatically switched in association with the irradiation timing of the white illumination light 3 and the excitation light 5 that irradiate the observation range P. Has a manual mode for manual switching. Therefore, the type of image to be displayed on the monitor 200 can be freely selected based on the doctor's intention.

  Such a monitor 200 can selectively display a color image, a fluorescence image, and a superimposed image, and can also selectively display a fluorescence spectrum measured by the fluorescence spectroscopic measurement unit 80. As a result, color images, fluorescence images, superimposed images, and fluorescence spectra can be selectively displayed in real time, and sentinel lymph nodes can be searched while monitoring the fluorescence spectrum. It can be identified quickly.

  As shown in FIG. 4, the timing control unit 150 is connected to the white illumination light source 50 and the excitation light source 80, and determines the ON / OFF timing of the driver for turning on and off the white illumination light source 50 and the excitation light source 70. Control. The timing may be controlled by providing a shutter and opening and closing the shutter. For example, when irradiating only the white illumination light 3 to the observation range P, only the white illumination light source 50 is turned on and the driver of the excitation light source 70 is turned off. Further, when only the excitation light 5 is irradiated to a predetermined part of the observation range P, the white illumination light source 50 is turned off and the driver of the excitation light source 70 is turned on. Further, when irradiating the observation range P with the white illumination light 3 and irradiating the excitation light 5 to a predetermined part of the observation range P, the white illumination light source 50 is turned on and the driver of the excitation light source 70 is turned on.

  The timing control unit 150 is connected to the superimposed image processing unit 140 and performs control so as to select the type of image to be displayed on the monitor 200 in association with the irradiation of the white illumination light 3 and the excitation light 5.

<Apparatus configuration connected to laparoscope for excitation>
FIG. 5 is a diagram showing an example of the device configuration of the excitation laparoscope 20 and various control devices connected to the excitation laparoscope 20.

(Laparoscope for excitation)
As shown in FIGS. 3 and 5, the excitation laparoscope 20 has an excitation waveguide 26 (hereinafter also referred to as an excitation optical fiber 26) inserted in a sheath tube 22. The sheath tube 22 has a certain rigidity and strength so that the excitation optical fiber 26 and the light receiving waveguide 27 (hereinafter also referred to as the light receiving optical fiber 27) inserted therein can be fixed in position. It is formed of an elongated member. The tips of the excitation optical fiber 26 and the light receiving optical fiber 27 inserted into the sheath tube 22 are aligned with the tips of the sheath tube 22. The distal end of the sheath tube 22 is provided with a transparent sealing portion 23 that seals the distal end. The transparent sealing portion 23 is also formed of a transparent member, and is configured to transmit the excitation light 5 that is emitted and the fluorescence 6 that is incident.

  Since the detailed contents of the excitation optical fiber 26 and the light receiving optical fiber 27 have already been described, they are omitted here. The excitation optical fiber 26 and the light receiving optical fiber 27 are branched by a branch portion 29, and the excitation optical fiber 26 extends from the rear end of the sheath tube 22 constituting the excitation laparoscope 20 to the excitation light source 70. Thus, it is protected by a resin coating process or a tube so as to be bent, and becomes an excitation cable 26 ′, which is connected to the excitation light source 70.

  On the other hand, the light receiving optical fiber 27 is connected to the fluorescence spectroscopic measurement unit 80 via the connector 81. As shown in FIG. 6, the connector 81 is provided with an elongated slit-like fiber array 85. The light receiving optical fiber 27 is rearranged so as to correspond to the shape of the fiber array 85, inserted into the fiber array 85, and connected to the fluorescence spectrometer 80. The light receiving optical fiber 27 is protected by a resin coating process or a tube so that it can be bent between the rear end of the sheath tube 22 constituting the excitation laparoscope 20 and the imaging unit 90 so as to be bent. The fiber 27 ′ is connected to the fluorescence spectroscopic measurement unit 80.

(Excitation light source)
The excitation light source 70 is a light source that emits excitation light 5, and includes, for example, a semiconductor laser that emits laser light and a driver that turns on and off the semiconductor laser. The excitation light of the excitation light source 70 is preferably a laser beam with a wavelength of 400 to 1000 nm, more preferably a laser beam with a wavelength of 700 to 900 nm, although it depends on the type of fluorescent material to be emitted. It is selected according to the fluorescent substance. The excitation light source 70 is connected to a timing control unit 150 (see FIGS. 1 and 4), and the ON / OFF timing of the driver is controlled. The driver ON / OFF timing is controlled in association with the turning on and off of the white illumination light source 50 described above. Note that the timing may be controlled by providing a shutter and controlling the timing of opening and closing the shutter. In this laparoscopic diagnostic apparatus 1, the timing of irradiating the white illumination light 3 and the excitation light 5 includes an automatic mode in which the timing controller 150 automatically switches, and also includes a manual mode in which the doctor manually switches. The timing of irradiation can be controlled based on the doctor's intention.

(Fluorescence spectroscopy measurement unit)
As shown in FIG. 5, the fluorescence spectroscopic measurement unit 80 is a device that spectrally analyzes and detects the fluorescence 6 received by the light receiving optical fiber 27, and performs spectroscopic analysis of only fluorescence having a preset desired wavelength. To detect. The fluorescence spectroscopic measurement unit 80 includes a filter (not shown) that cuts the excitation light 5 out of the excitation light 5 and the fluorescence 6 received by the light receiving optical fiber 27 and passes only the fluorescence 6. A light receiving optical fiber 27 is connected to the fluorescence spectroscopic measurement unit 80 via a connector 81.

  The measurement result in the fluorescence spectroscopic measurement unit 80 is displayed on the monitor 200 as necessary via the measurement result display control unit 160 (see FIG. 1). The monitor 200 may digitize and display the luminance for each wavelength obtained by analyzing the spectrum, or may display a graph for each wavelength based on the digitized luminance. The doctor determines whether or not the fluorescence 6 emitted from the fluorescent material is detected, and by what intensity, by analyzing the numerical values and graphs displayed on the monitor 200. As described above, the detection result and the spectral result may be displayed using two or more monitors.

  When fluorescent substances are present at these sites by using fluorescent substances that bind to blood vessels B, lymphatic vessels R and sentinel lymph nodes S, as shown in FIG. The fluorescence 6 is emitted. The fluorescence spectroscopic measurement unit 80 detects the fluorescence spectrum in which the fluorescence 6 emitted from the fluorescence substance existing in the blood vessel B, the lymph vessel R, and the sentinel lymph node S emits light with the wavelength of the detected fluorescence 6 set in advance. To do. As a result, a place where the fluorescence intensity emitted from the fluorescent material is high can be identified accurately and quickly. When a different fluorescent material is used, the filter built in the fluorescence spectroscopic measurement unit 80 may be replaced. The sentinel lymph node S is identified by measuring a color image and a fluorescence image for a place (a plurality of) having a high fluorescence spectrum intensity, and displaying the color image and the fluorescence image in a superimposed manner, thereby forming the shape of the superimposed image. The doctor identifies the sentinel lymph node S based on the positional relationship with the lesioned part C.

  The fluorescence spectroscopic measurement unit 80 is connected to the measurement result display control unit 160 (see FIG. 1) of the control device 100. When the fluorescence spectroscopic measurement unit 80 detects the fluorescence 6 from the fluorescent substance, the measurement result display control is performed. The detection result is displayed on the monitor 200 based on the command from the unit 160. In the laparoscopic diagnosis apparatus 1, the measurement result obtained by the fluorescence spectroscopic measurement unit 80 may be displayed on the same monitor 200 together with the image, or may be displayed on two or more monitors.

[Sentinel lymph node examination method]
A sentinel lymph node inspection method using the thus constructed laparoscopic diagnosis apparatus 1 will be described with reference to FIG. FIG. 7A is a color image of the surface of a lesioned part C imaged with an imaging laparoscope, and FIG. 7B is a fluorescent image (black and white image) at the same location. 7A is a color image, and blood vessel B, lymph vessel R, and sentinel lymph node S in FIG. 7B all appear white in a black and white image, and the others are black or substantially black. appear.

  FIG. 7C is an image in which a color image and a fluorescence image are superimposed. Image information on the surface of the lesioned part C is obtained from the color image shown in FIG. 7A, and blood vessels B and lymph vessels R are obtained from the fluorescence image (black and white image) shown in FIG. 7B obtained simultaneously with the image information. 7C is obtained, and the superimposed image shown in FIG. 7C is displayed by superimposing both pieces of image information, so that the lesion C (color image), blood vessel B (monochrome image), lymph vessel R (monochrome) Image) and sentinel lymph node S (black and white image) are all displayed. The sentinel lymph node S can be identified from information such as the positional relationship with the lesion part C peculiar to the sentinel lymph node S, the shape, and the relative luminance displayed in the superimposed image. This identification is performed by a physician.

  When the position of the sentinel lymph node S is specified using the laparoscopic diagnostic apparatus 1, a fluorescent substance that specifically binds to the blood vessel, lymph vessel, and sentinel lymph node S is administered in advance. The fluorescent substance administered to the patient emits a fluorescent spectrum peculiar to the fluorescent substance when irradiated with the excitation light 5. Therefore, the location where the sentinel lymph node S is likely to exist can be searched by detecting the fluorescence 6 and quickly and accurately identifying the position where the fluorescence intensity is strong from the fluorescence spectrum.

  Since the laparoscopic diagnostic apparatus 1 has the imaging laparoscope 10 and the excitation laparoscope 20 independently, the excitation light 5 is applied to a relatively free irradiation range with respect to the observation range P imaged by the imaging laparoscope 10. Can be irradiated. By separating the excitation laparoscope 20 from the observation unit, the irradiation range of the excitation light 5 can be made wider than the imaging range of the imaging laparoscope 10. By doing so, it is possible to quickly search for a position where the fluorescence intensity is strong as compared with the case of searching using a fluorescent image that is normally performed. When the excitation laparoscope 20 is separated from the observation unit, the fluorescence intensity becomes relatively low. However, by measuring the fluorescence 6 received by the light receiving optical fiber 27 of the excitation laparoscope 20 with the fluorescence spectroscopic measurement unit 80. Thus, it can be measured with higher sensitivity than the fluorescence image, and the sentinel lymph node S can be searched.

  FIG. 8A is a schematic graph showing the result of the fluorescence spectrum obtained by moving the excitation laparoscope 20 and searching for a place with high fluorescence intensity, and FIG. It is a typical graph which shows the relationship with the time of the fluorescence intensity which plotted the peak intensity of the fluorescence spectrum based on the result obtained by A). Reference numerals 1 to 5 in FIGS. 8A and 8B represent positions (time) when the excitation light 5 is irradiated while moving the excitation laparoscope 20. The fluorescence intensity increases from code 1 to code 5, and from the measurement results in this range, it can be confirmed that a place with high fluorescence intensity exists at the position of code 5. In addition, the position of the code | symbol 5 can be confirmed by monitoring the fluorescence image obtained by moving the imaging laparoscope 10. FIG.

  By measuring the fluorescence spectrum shown in FIG. 8A, a change in the fluorescence intensity position can be easily determined as a change in the fluorescence spectrum intensity. As a result, individual differences in the search time of the sentinel lymph node S can be reduced as compared with the conventional method of judging from the fluorescence image. In addition, since it is considered that there is a high probability that the sentinel lymph node S exists in a place where the fluorescence intensity is high, the sentinel lymph node S can be identified by searching for a place where the intensity of the fluorescence spectrum measured by the fluorescence spectrometer 80 is high. It is possible to achieve an exceptional effect that can be performed accurately and quickly. Further, by narrowing the irradiation range by bringing the excitation laparoscope 20 close to the observation part, it is possible to narrow the position of high fluorescence intensity in a narrow range, and to search for the sentinel lymph node S quickly. In addition, the sentinel lymph node S is identified by acquiring a color image and a fluorescence image at a place where the fluorescence spectrum intensity is high, and displaying the color image and the fluorescence image in a superimposed manner, so that The doctor can identify the sentinel lymph node based on the positional relationship of the. The sentinel lymph node can be identified by repeating this measurement for a place having a high fluorescence spectrum intensity.

  In order to identify the sentinel lymph node S, in the laparoscopic diagnostic apparatus 1 according to the present invention, the white illumination light source 50 and the imaging laparoscope 10 are connected, and the excitation light source 70 and the excitation laparoscope 20 are connected. Then, the white illumination light 3 and the excitation light 5 are irradiated to the position where the fluorescence intensity is high, the reflected light 4 and the fluorescence 6 are received by the imaging waveguide 16, and the light is guided to the imaging unit 90 to be color images and fluorescence. Acquire images in a superimposed manner. At the same time, the fluorescence 6 emitted from a position with high fluorescence intensity is received by the excitation laparoscope 20 and guided to the fluorescence spectroscopic measurement unit 80 to obtain a fluorescence spectrum. In this way, image information and fluorescence spectrum information at a position with high fluorescence intensity can be acquired simultaneously. Whether the cancer has metastasized can be determined by taking a sentinel lymph node S and conducting a pathological examination to determine whether cancer cells are present in the sentinel lymph node S. Accurate and accurate identification of the sentinel lymph node S is important for reducing the burden on the patient and reducing the risk of infection by shortening the operation time.

  As described above, the laparoscopic diagnostic apparatus 1 and the sentinel lymph node inspection method using the laparoscopic diagnostic apparatus 1 according to the present invention are the imaging laparoscope having the white illumination waveguide 17 and the imaging waveguide 16. 10 and the excitation laparoscope 20 having the excitation waveguide 26 and the light reception waveguide 27 are provided independently, so that the irradiation position P (“irradiation range”) of the white illumination light 3 irradiated from the imaging laparoscope 10 is provided. And the same applies hereinafter), and the irradiation position P of the excitation light 5 irradiated from the exciting laparoscope 20 (the “irradiation range” is also the same; the same applies hereinafter) can be changed. As a result, the search range of the sentinel lymph node S can be changed relatively freely by changing the irradiation range by changing the distance between the irradiation position and the excitation laparoscope 20. Further, when simultaneously measuring a color image and a fluorescent image, the near-infrared cut filter 54 is inserted into the white illumination light 3 to cut a wavelength longer than the near-infrared light that excites the fluorescent substance, so that in the fluorescent wavelength band Generation of noise can be suppressed. As a result, the excitation light 5 is irradiated by the excitation laparoscope 20 onto the observation range P of the white illumination light 3 irradiated by the imaging laparoscope 10, and thus the fluorescence obtained from the color image obtained from the reflected light 4 and the fluorescence 6. Images can be simultaneously acquired with the same imaging laparoscope to perform superimposed image processing. As a result, the color image and the fluorescence image in the observation range P can be obtained in a superimposed manner in real time. Further, since the received fluorescence 6 can be sent to the fluorescence spectroscopic measurement unit 80 by the exciting laparoscope 20, the fluorescence spectrum can be measured simultaneously with the image acquisition. By measuring the fluorescence spectrum that can be measured with high sensitivity, the location of the sentinel lymph node S can be accurately and quickly searched, and the location of the sentinel lymph node S can be easily identified as a result. Can do. In addition, by observing fluorescence spectra with different relative intensities on the monitor according to the irradiation position of the excitation light 5, it is possible to search for a place with high fluorescence intensity, and to reduce individual differences in the position search time of the sentinel lymph node S.

[Laparoscopic diagnostic apparatus according to another embodiment]
(Example having a fluorescence intensity measurement unit)
FIG. 9 is a schematic configuration diagram illustrating another example of the exciting laparoscope and various control devices. In the laparoscopic diagnostic apparatus according to the present invention, as another form of the excitation laparoscope 20, a light receiving waveguide composed of a plurality of light receiving optical fibers 27 can be characterized. Specifically, as shown in FIG. 9, a part of the plurality of light receiving optical fibers 27 is connected to a fluorescence spectroscopic measuring unit 80 for measuring a fluorescence spectrum, and the remaining light receiving optical fibers 27 are connected. The fluorescence intensity measuring unit 82 for measuring the intensity of the fluorescence 6 is connected. Then, the fluorescence spectrum measured by the fluorescence spectroscopic measurement unit 80 and the fluorescence intensity measured by the fluorescence intensity measurement unit 82 are displayed on the monitor 200.

  The fluorescence intensity measuring unit 82 is an apparatus that measures the intensity of the fluorescence 6, and is an apparatus to which some of the light receiving optical fibers 27 divided by the connector 81 among the light receiving optical fibers 27 are connected. The fluorescence intensity measuring unit 82 includes means for selecting a fluorescence wavelength band and means for detecting weak light such as a photomultiplier tube. By adopting such a configuration, it is possible to measure fluorescence intensity with high sensitivity simultaneously with spectroscopic measurement of fluorescence 6.

  As shown in FIG. 9, the light receiving optical fiber 27 is divided and connected to a fluorescence spectroscopic measurement unit 80 and a fluorescence intensity measurement unit 82 via a connector 81. As shown in FIGS. 6 and 10B, the connector 81 includes a connector 81A in which a strip-shaped fiber array 85A is constituted by a light receiving optical fiber 27a connected to the fluorescence spectroscopic measurement unit 80, and a fluorescence intensity measurement unit 82. It is preferable that the light receiving optical fiber 27b connected to the connector 81B includes a connector 81B having a circular fiber array 85B.

  The strip-shaped connector 81A has a configuration in which the light receiving optical fiber 27a is inserted into a long and narrow slit, and the thus configured fiber array 85A is connected to the fluorescence spectroscopic measurement unit 80, so that the spectral sensitivity is increased, and the slit By narrowing the width, fluorescence spectroscopic measurement with improved wavelength resolution can be performed. On the other hand, the circular connector 81B has a configuration in which the light receiving optical fibers 27b are inserted and arranged in a cylinder, and the fiber array 85B thus configured is connected to the fluorescence intensity measuring unit 82. The fluorescence intensity measurement unit 82 has a transmission wavelength filter that selects a fluorescence wavelength, and includes a photomultiplier tube for measuring the selected fluorescence wavelength with high sensitivity.

  As shown in FIG. 10A, the plurality of light receiving optical fibers 27 in the cross section of the excitation laparoscope 20 are provided so as to surround the single excitation optical fiber 26 at the center. . The arrangement of the plurality of light receiving optical fibers 27 is not particularly limited, but the arrangement of the light receiving optical fibers 27a connected to the fluorescence spectroscopic measurement unit 80 and the arrangement of the light receiving optical fibers 27b connected to the fluorescence intensity measuring unit 82 are distinguished. It is preferable to do. For example, as shown in FIG. 10A, the light receiving optical fiber 27a connected to the fluorescence spectroscopic measurement unit 80 is arranged around the excitation optical fiber 26 and is connected to the fluorescence intensity measuring unit 82. Is preferably arranged further around the light receiving optical fiber 27a.

  If such an excitation laparoscope 20 is used, the fluorescence intensity measurement unit 82 can measure the intensity of the fluorescence 6 emitted from the fluorescent material by irradiating the excitation light 5 from the excitation laparoscope 20. Therefore, by moving the location of the excitation laparoscope 20, the fluorescence intensity at the moved location can be measured. By specifying the measured fluorescence intensity and the location where the excitation laparoscope 20 moves, it is useful for searching for a place with high fluorescence intensity, and as a result, the position of the sentinel lymph node can be contributed to speeding up the specification.

  Note that the result of fluorescence intensity measurement by the fluorescence intensity measurement unit 82 can be used in the same manner as the search for a place with high fluorescence intensity based on the fluorescence spectrum described in FIG. As shown in FIG. 8B, the fluorescence intensity measurement results can be measured at a higher speed than the fluorescence spectrum, with time series data in which the horizontal axis represents time and the vertical axis represents the relative intensity of fluorescence. As a result, a change in fluorescence intensity (direction in which the fluorescence intensity increases) can be detected at high speed, and the search time can be shortened. By using the measurement result of the fluorescence intensity and the fluorescence spectrum in combination, the search for the sentinel lymph node performed while moving the laparoscope for excitation 20 and the imaging laparoscope 10 indicates that the fluorescence spectrum is fluorescence. Therefore, it is possible to reliably search for a place where the fluorescent intensity from the fluorescent substance is strong.

  As a specific search procedure, first, a small amount of reagent (for example, indocyanine green: ICG) is injected into the submucosa by gastroscopy during the operation, or by using a laparoscope from outside the gastric wall. Inject. After injecting the reagent, the search is started with the laparoscope 20 for excitation after waiting for the fluorescent substance to be taken into the lymphatic vessel or the sentinel lymph node. Since the lesion also fluoresces, it is easy to confirm the site. The imaging laparoscope 10 and the excitation laparoscope 20 are inserted in the vicinity thereof. First, a color image is acquired with the imaging laparoscope 10 and the insertion position of the excitation laparoscope 20 and the irradiation position of the excitation light 5 are confirmed. The excitation light 5 is irradiated from the excitation laparoscope 20, the fluorescence 6 emitted from the fluorescent material is received, guided to the fluorescence spectroscopic measurement unit 80 by the light receiving optical fiber 27, and a fluorescence spectrum peculiar to a reagent such as ICG is obtained. While measuring, the intensity | strength is also measured by the fluorescence intensity measurement part 82. FIG.

  The measured fluorescence spectrum becomes relatively large in proportion to the concentration of the fluorescent substance. The fluorescence spectrum can be measured with higher sensitivity than the fluorescence image. As shown in FIG. 8A, the higher the concentration of the fluorescent substance, the larger the peak of the fluorescence spectrum (corresponding to the fluorescence intensity), and the closer to the position where the fluorescence intensity is high. Therefore, it is possible to easily search and determine a place where the fluorescence intensity is high, that is, a place where a sentinel lymph node is highly likely to exist. Then, the imaging laparoscope 10 is moved to that location, a color image and a fluorescence image are taken, and it is determined whether or not it is a sentinel lymph node by the superimposed image. By repeating this search, the position of the sentinel lymph node can be searched and specified.

  Since the fluorescence spectrum and the fluorescence intensity can be monitored simultaneously and in real time by such a sentinel lymph node inspection method using the laparoscopic diagnostic apparatus 1, the fluorescence spectrum, the color image, and the image result obtained by superimposing the fluorescence image are obtained. Simultaneous and real-time monitoring is possible. As a result, the search and inspection of the sentinel lymph node S existing in the observation range P can be performed easily and accurately. With this examination method, the position of the sentinel lymph node can be identified by a laparoscope, and the treatment policy can be determined by rapid pathological examination or the like.

(Example having multiple fluorescence intensity measuring units)
FIG. 11 is a schematic configuration diagram illustrating still another example of the exciting laparoscope and various control devices. This apparatus is different from the apparatus of FIG. 9 having one fluorescence intensity measurement unit 82 in that it has a plurality of fluorescence intensity measurement units 82 (four in the example of FIG. 11).

  That is, a part of the plurality of light receiving optical fibers 27 is connected to a fluorescence spectroscopic measuring unit 80 that measures the fluorescence spectrum, and the remaining light receiving optical fibers 27b are measured for the intensity of the fluorescence 6. The plurality of fluorescence intensity measuring units 82 are connected. At this time, the remaining light receiving optical fibers 27b are divided so as to correspond to the irradiation positions of the excitation light. The divided light receiving optical fibers 27b constitute fiber arrays 85B similar to those shown in FIG. Each fiber array 85B is connected to a plurality of fluorescence intensity measuring units 82A to 82D as shown in FIG.

  Here, “divided so as to correspond to the irradiation position of the excitation light” means, for example, that in the cross-sectional view of FIG. The fibers 27b are bundled and connected to the fluorescence intensity measuring unit 82A as one fiber array 85B, and the left light receiving optical fibers 27b are bundled and connected to the fluorescence intensity measuring unit 82B as one fiber array 85B in plan view. The lower receiving optical fibers 27b are bundled together as viewed and connected to the fluorescence intensity measuring unit 82C as one fiber array 85B, and the right receiving optical fibers 27b are bundled together as seen in plan view as one fiber array 85B. Connect to the part 82D. The positions divided into upper, lower, left, and right are displayed so that the corresponding positions can be seen by the excitation laparoscope, and alignment is performed when the excitation laparoscope is inserted into the patient.

  With such a configuration, it is possible to measure fluorescence intensity with high sensitivity simultaneously with fluorescence spectroscopic measurement, and in addition, a portion where fluorescence intensity is strong in any of the upper, lower, left, and right directions where the excitation light 5 is irradiated. I know if there is. Then, by moving the excitation laparoscope 20 in a direction in which the output is large and the time series change of the output is large among the four fluorescence intensity measuring devices 82A to 82D, the search for the sentinel lymph node is further facilitated. .

  As described above, the monitor 200 displays a plurality of pieces of fluorescence intensity information measured by the plurality of fluorescence intensity measuring units 82A to 82D, and guides the imaging laparoscope 10 in a direction in which the fluorescence intensity is strong. The image information obtained in this way is displayed.

  12 and 13 show the fluorescence intensity measurement results obtained by moving the excitation laparoscope 20 and searching for sentinel lymph nodes, and the fluorescence intensity measurement when simultaneously measured by a plurality of fluorescence intensity measuring instruments 82A to 82D. It is a typical graph which shows the example of the search method used together with the result. As described above, the search time can be shortened only by the measurement result of the fluorescence spectrum shown in FIG. 8A obtained by the apparatus having one fluorescence intensity measurement unit 82 (see FIG. 8A). The measurement results obtained by the apparatus (see FIG. 11) having the four fluorescence intensity measuring units 82A to 82D are displayed as a bar graph (see FIG. 12B), and the moving direction is displayed with a display and an arrow. By navigating the search direction, the search time for sentinel lymph nodes can be further reduced.

  It is preferable to display the measurement results shown in FIGS. 12A and 12B and the measurement results shown in FIGS. 13A and 13B on one or more monitors 200.

  The fluorescence spectrum to be displayed on the monitor 200 can display the trend of changes in an easy-to-understand manner by displaying the current spectrum as 5 and displaying the past fluorescence spectra as 4 to 1. The sampling time can be set arbitrarily, but can be adjusted at intervals of 0.1 seconds to 5 seconds, for example, 0.1 seconds. At the same time, it is preferable to display the signals of the fluorescence intensity measuring units 82A to 82D as bar graphs on the same screen. It may be difficult to determine which direction to move in the fluorescence spectrum. The direction of high fluorescence intensity is displayed and the arrow (→) display is also used in combination with the display so that it can be seen visually. The search can be performed in a shorter time.

  In the laparoscopic diagnostic apparatus 1 according to the present invention, a search can be performed more efficiently by setting a threshold value for the fluorescence intensity result. That is, by setting a threshold value for the fluorescence intensity result, control is performed to search for a place where the peak intensity of the fluorescence spectrum is greater than or equal to the threshold value. In the control, the result that the peak intensity of the fluorescence spectrum is greater than or equal to a threshold value is displayed in real time on the monitor, and whether or not the value exceeds the threshold value is determined by the control. By doing so, the fluorescence spectrum and the fluorescence intensity can be monitored simultaneously and in real time.

  As described above, by configuring to have the fluorescence intensity measurement unit 82, a part of the plurality of light receiving optical fibers 27a (light receiving waveguides) can be connected to the fluorescence spectroscopy measurement unit 80 to obtain a fluorescence spectrum, The remaining light receiving optical fiber 27b (light receiving waveguide) can be connected to one or a plurality of fluorescence intensity measuring units 82 for measuring the fluorescence intensity to obtain the fluorescence intensity. Furthermore, the monitor 200 displays the fluorescence intensity information measured by one or a plurality of fluorescence intensity measuring units 82 and also displays the image information obtained by guiding the imaging laparoscope 10 in the direction of strong fluorescence intensity. Therefore, the search time can be shortened only by the fluorescence spectrum, but in addition, the measurement result in the fluorescence intensity measurement unit 82 is displayed, and imaging is performed in the direction in which the fluorescent substance is more presumed based on the result. Since the laparoscope 10 is guided, it is possible to search for a position with a strong fluorescence intensity more quickly. As a result, the search time for sentinel lymph nodes can be further shortened.

[Sentinel lymph node examination method]
The inspection method for sentinel lymph nodes according to the present invention is an inspection method performed using the above-described laparoscopic diagnostic apparatus 1 according to the present invention. That is, the imaging illumination laparoscope 10 that irradiates the observation range P with the white illumination light 3 and receives the reflected light 4 reflected from the observation range P and guides it to the imaging unit 90, and the excitation light that excites the fluorescent substance. 5 is applied to the observation range P, and the laparoscopic diagnosis is independently provided with the excitation laparoscope 20 that receives the fluorescence 6 emitted from the fluorescent substance existing in the observation range P and guides it to the fluorescence spectroscopic measurement unit 80. This is an inspection method using the apparatus 1. Then, image information obtained by imaging the optical signal (reflected light 4 and fluorescence 6) received by the imaging laparoscope 10 and the optical signal (fluorescence 6) received by the excitation laparoscope 20 are measured by the fluorescence spectroscopic measurement unit 80. The fluorescence spectrum measured in (1) is acquired simultaneously and in time series, and the time-series change of the fluorescence spectrum is measured to obtain sentinel lymph node examination information.

  According to such an inspection method, a laparoscopic diagnosis including an imaging laparoscope 10 having a white illumination waveguide and an imaging waveguide, and an excitation laparoscope 20 having an excitation waveguide and a light receiving waveguide independently. Since the apparatus 1 is used, the irradiation position P and irradiation range of the white illumination light 3 irradiated from the imaging laparoscope 10 and the irradiation position P and irradiation range of the excitation light 5 irradiated from the excitation laparoscope 20 can be changed. it can. As a result, the search range of the sentinel lymph node can be arbitrarily changed. Moreover, generation | occurrence | production of the noise in the fluorescence wavelength band by cutting the excitation light wavelength band of the white illumination light 3 can be suppressed. Further, since the excitation light 5 is irradiated from the excitation laparoscope 20 to the observation range P of the white illumination light 3 irradiated from the imaging laparoscope 10, a color image and a fluorescent material obtained from the reflected light 4 of the white illumination light 3 Since the fluorescence image obtained from the fluorescence 6 emitted from can be acquired with the same imaging laparoscope 10, each image at the same place can be acquired. Further, image information obtained by imaging the optical signal (reflected light 4 and fluorescence 6) received by the imaging laparoscope 10 and a fluorescence spectrum obtained by imaging the optical signal (fluorescence 6) received by the excitation laparoscope 20 By acquiring the results simultaneously and in time series, and measuring the time series change of the fluorescence image, it is possible to easily and quickly search for a place with high fluorescence intensity where the existence probability of the sentinel lymph node is considered to be high. By acquiring and superimposing a color image and a fluorescence image at that location, the sentinel lymph node is identified based on the shape of the superimposed image and the positional relationship with the lesion. As a result, the sentinel lymph node can be searched accurately and quickly.

  Prior to the examination of the sentinel lymph node S, a fluorescent substance that combines with the sentinel lymph node S and emits near-infrared fluorescence 6 by the excitation light 5 is injected or administered and supplied to the region including the observation range P. The fluorescent substance supplied to the sentinel lymph node is allowed to react.

  Such a sentinel lymph node inspection method according to the present invention has been described as needed in the description of the laparoscopic diagnosis apparatus 1 described above, but will be specifically described based on the following procedures (1) to (7).

(1: Preparation stage to search for lesion)
First, the imaging laparoscope 10 is used to irradiate the white illumination light 3 from the imaging laparoscope 10 to confirm the observation position P with a color image, thereby determining the search start location.

(2: Preparatory stage to search for sentinel lymph nodes)
The excitation laparoscope 20 is moved in a state where a color image is obtained by the imaging laparoscope 10 so that the excitation light 5 emitted from the excitation laparoscope 20 can be observed by the imaging laparoscope 10. The position of the excitation light 5 of the excitation laparoscope 20 is confirmed from the captured color image. At this time, a camera capable of confirming the excitation light 5 with a color image is used, or visible light is inserted into the excitation light 5 so that observation can be performed.

(3: Sentinel lymph node examination preparation stage)
After the above preparation, a fluorescent material, such as indocyanine green (ICG), is injected into the place where the lymph nodes are likely.

(4: Search stage)
While irradiating the excitation light 5 of the excitation laparoscope 20, the irradiation position of the excitation laparoscope 20 is moved while observing the fluorescence spectrum acquired by the fluorescence spectroscopic measurement unit 80 with a monitor. A place where a pattern (hereinafter referred to as a specific pattern) corresponding to a case where the administered fluorescent substance is combined with a lymph node is obtained by a fluorescence spectrum is searched. Initially, it is preferable to search by increasing the intensity of the excitation light 5 and increasing the detection sensitivity of the fluorescence 6. Further, it is more preferable to increase the search area by irradiating the excitation light 5 to a wide place with the distance between the excitation laparoscope 20 and the search place widened. Then, the fluorescence spectrum measured by the fluorescence spectroscopic measuring unit 80 and the fluorescence intensity measured by the fluorescence intensity measuring unit 82 are displayed side by side on the monitor, and the excitation laparoscope 20 is moved to search for a direction in which the fluorescence intensity increases. . The search time can be shortened by displaying image information (navigation display, upper right display and arrow display in FIGS. 12 and 13) for guiding the excitation laparoscope simultaneously with the display of the fluorescence intensity.

(5: Specific stage of sentinel lymph node)
After detecting the fluorescence spectrum of a specific pattern, the excitation laparoscope 20 is moved to a position where the intensity of the fluorescence spectrum is the strongest and fixed. Next, the imaging laparoscope 10 is moved to that position. The imaging laparoscope 10 is set to a mode for continuously capturing fluorescent images. The imaging laparoscope 10 is fixed at a place where the fluorescence intensity is high in the fluorescence image or a place where the highest fluorescence intensity is at the center or substantially the center of the fluorescence screen.

(6: Sentinel lymph node image acquisition stage)
A normal image is acquired by irradiating white illumination light 3 from the imaging laparoscope 10. Observe the surface condition with normal images. In addition, the excitation light 5 is irradiated by the excitation laparoscope 20 and a fluorescence image is obtained simultaneously with the measurement of the fluorescence spectrum. The fluorescence image is acquired by the imaging laparoscope 10 and this fluorescence image is superimposed on the previously obtained normal image (color image). An image is formed (see FIG. 7C).

(7: Collection of sentinel lymph nodes)
The part which seems to be sentinel lymph node is collected with a laparoscope for operation. The previous superimposed image is used for collection. Also. Confirmation of whether or not collection is possible is also confirmed by a superimposed image (if it can be collected, the fluorescence disappears after excision). After this, a pathological examination is performed to check if cancer has spread to the sentinel lymph nodes, and the surgical strategy is determined.

  As described above, the sentinel lymph node S can be searched quickly by searching for a portion having a high fluorescence spectrum intensity. In the detection of the fluorescence spectrum, a position with high fluorescence intensity can be detected with higher sensitivity than the fluorescence image acquired by the imaging laparoscope, so that even when a small amount of fluorescent substance is administered, a little time has passed since the administration of the fluorescent substance. It is possible to search with high sensitivity the place where the fluorescent material is contained from the stage where it is not. Further, by displaying the change in the peak of the fluorescence spectrum, it is possible to easily determine the position where the fluorescence intensity is high. In the conventional determination of the fluorescent image, individual differences are likely to occur because the determination is based on visual changes in the screen brightness, and the detection sensitivity is low. In the sentinel lymph node inspection method according to the present invention, the excitation light 5 is spread and irradiated, and the fluorescence spectrum can be detected with a plurality of light receiving optical fibers 27 with high sensitivity. Search can be performed, search time can be shortened, and a position with high fluorescence intensity can be detected accurately.

  Furthermore, in the present invention, the position where the fluorescence intensity is strong can be searched in a short time because the sensitivity of the fluorescence spectrum is high, the response speed is fast, and the irradiation range P of the excitation light 5 can be widened. The time for searching for nodes can be shortened.

  In addition to the fluorescence spectrum, the fluorescence intensity is detected by using one or more fluorescence intensity measuring units 82 that measure the intensity of the specific fluorescence 6 corresponding to the excitation light 5, for example, as shown in FIGS. 12 and 13. Thus, simultaneously with the fluorescence spectrum, position information in the four directions of the fluorescence intensity corresponding to the irradiation position can be obtained. With such position information of the fluorescence intensity, the output from the fluorescence intensity measurement unit 82 can be utilized, the search direction for the sentinel lymph node can be navigated, and the search time can be further shortened.

  In addition to displaying the fluorescence intensity display as a visual bar graph or the like, displaying the direction of movement, or performing navigation for displaying the direction of movement with arrows, the search time can be greatly reduced.

  Further, an image obtained by imaging the optical signal received by the imaging laparoscope 10, the fluorescence 6 generated by irradiating the excitation light 5 with the excitation laparoscope 20, and a part of the excitation light 5 are received and the fluorescence signal is received. The fluorescence image obtained by taking out the fluorescence image is acquired simultaneously and in time series, and the time series change of the fluorescence image is measured to examine the sentinel lymph node, so that the fluorescent substance can be searched immediately after injection.

DESCRIPTION OF SYMBOLS 1 Laparoscope diagnostic apparatus 3 White illumination light 4 Reflected light 5 Excitation light 6 Fluorescence 10 Imaging laparoscope 11 Holder 12 Sheath tube 13 Transparent sealing part 15 Lens 16 Imaging waveguide (Optical fiber bundle for imaging)
17 Waveguide for white illumination (optical fiber for white illumination)
17a White illumination cable 18 Imaging cable 19 Restraining means 20, 20A Excitation laparoscope 21 Holder 22 Sheath tube 23 Transparent sealing part 24 Diaphragm lens (irradiation range diaphragm part)
25 Fiber Bundle 26 Excitation Waveguide (Excitation Optical Fiber)
26 'Excitation cable 27, 27a, 27b Light receiving waveguide (light receiving optical fiber)
27 'light receiving cable 28 restraining means (band holder)
29 Branch

DESCRIPTION OF SYMBOLS 50 White illumination light source 51 Lamp 52 Electrode 53 Reflection mirror 54 Near-infrared cut filter 70 Excitation light source 80 Fluorescence spectroscopy measuring part (fluorescence spectroscopy measuring device)
81, 81A, 81B Connectors 82, 82A, 82B, 82C, 82D Fluorescence intensity measurement unit 84 Fluorescence spectroscopy measurement unit Light guide waveguide for guiding light 85, 85A, 85B Fiber array 90 Imaging unit 91 Housing 92 Dichroic mirror (light separation) mechanism)
93, 94 CCD camera 95 Excitation light cut filter 100 Control device 110 Image processing unit 120 Normal image processing unit 130 Fluorescent image processing unit 140 Superimposed image processing unit 150 Timing control unit 160 Measurement result display control unit 200, 201 Monitor

P observation range H insertion slot S sentinel lymph node C lesion B blood vessel R lymphatic vessel

Claims (10)

An imaging laparoscope having a white illumination waveguide that irradiates the observation range with white illumination light, an imaging waveguide that receives reflected light reflected from the observation range and guides the reflected light to the imaging unit, and a fluorescent material. An excitation waveguide that irradiates the observation range with excitation light to be excited, and a fluorescent material that is present in the observation range receives fluorescence emitted by the excitation light, and guides the received fluorescence to a fluorescence spectrometer. An excitation laparoscope having a light receiving waveguide, and
The imaging laparoscope has the white illumination waveguide connected to a white illumination light source, and is connected to the imaging unit that captures the reflected light and the fluorescence received by the imaging waveguide as a color image and a fluorescence image. The excitation laparoscope is characterized in that the excitation waveguide is connected to an excitation light source, and the light receiving waveguide is connected to the fluorescence spectroscopic measurement unit that measures the received fluorescence. Laparoscopic diagnostic equipment.   The laparoscopic diagnostic apparatus according to claim 1, further comprising a monitor that displays a fluorescence spectrum measured by the fluorescence spectrometer.   The laparoscopic diagnostic apparatus according to claim 1, wherein in the imaging laparoscope, the white illumination waveguide is disposed at a position surrounding the imaging waveguide.   4. The excitation laparoscope, wherein the excitation optical waveguide is a single excitation optical fiber, and the light reception waveguide is a plurality of light reception optical fibers surrounding the excitation optical fiber. The laparoscopic diagnostic apparatus according to any one of the above.   The light receiving waveguide is a plurality of light receiving optical fibers, a part of the light receiving optical fiber is connected to the fluorescence spectroscopic measurement unit for measuring a fluorescence spectrum, and the remaining light receiving optical fibers measure fluorescence intensity. The laparoscopic diagnosis apparatus according to claim 1, wherein the laparoscopic diagnosis apparatus is connected to a fluorescence intensity measurement unit that performs the display and displays the fluorescence spectrum and the fluorescence intensity on the monitor. In a laparoscopic diagnostic device that searches for sentinel lymph nodes by measuring fluorescence emitted by a fluorescent substance using an imaging laparoscope and an excitation laparoscope,
The excitation laparoscope has one excitation waveguide that irradiates excitation light that excites the fluorescent material, and a plurality of light guides fluorescence emitted from the fluorescent material to the fluorescence spectroscopic measurement unit by the excitation light irradiation. And a light receiving waveguide.
A laparoscopic diagnostic apparatus comprising a monitor that displays the fluorescence spectrum measured by the fluorescence spectroscopy measurement unit in a time series.   A part of the plurality of light receiving waveguides is connected to the fluorescence spectroscopic measurement unit, the remaining light receiving waveguides are connected to a plurality of fluorescence intensity measuring units for measuring fluorescence intensity, and the monitor is connected to the plurality of light receiving waveguides. A plurality of pieces of fluorescence intensity information measured by the fluorescence intensity measuring unit are displayed, and image information obtained by guiding the excitation laparoscope and the imaging laparoscope in a direction in which the fluorescence intensity is strong is displayed. The laparoscopic diagnostic apparatus according to 6. While irradiating the observation area with white illumination light, receiving the reflected light reflected in the observation area and guiding it to the imaging unit, and irradiating the observation area with excitation light for exciting the fluorescent material A method for inspecting sentinel lymph nodes using a laparoscopic diagnostic apparatus that independently includes an excitation laparoscope that receives fluorescence emitted from a fluorescent substance existing in the observation range and guides the fluorescence to a fluorescence spectroscopic measurement unit. ,
The image information obtained by imaging the optical signal received by the imaging laparoscope and the fluorescence analysis result obtained by analyzing the optical signal received by the excitation laparoscope by the fluorescence analysis means are acquired simultaneously and in time series. A method for inspecting sentinel lymph nodes, comprising measuring time-series changes in the fluorescence analysis results, and displaying the measurement results on a monitor as inspection information for sentinel lymph nodes.   The sentinel according to claim 8, wherein the fluorescent material for visualizing a sentinel lymph node is included in an area including the observation range, and the sentinel lymph node around the lesion is identified by receiving fluorescence emitted from the fluorescent material. Examination method of lymph nodes. The fluorescence analyzing means is a fluorescence spectrometer and a fluorescence intensity measuring device, and the monitor is a time-series change of a fluorescence spectrum measured by the fluorescence spectrometer and a fluorescence intensity measured by the fluorescence intensity measuring unit. Information and
10. The sentinel lymph node inspection method according to claim 8, wherein the excitation laparoscope and the imaging laparoscope are guided in a direction in which the fluorescence intensity is strong.

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