JP6554089B2 - 組織酸素化の測定用の器具、システムおよびメソッド - Google Patents
組織酸素化の測定用の器具、システムおよびメソッド Download PDFInfo
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- A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
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- A61B5/14556—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters for measuring blood gases by fluorescence
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- A61B5/1459—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters invasive, e.g. introduced into the body by a catheter
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- A61M5/007—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests for contrast media
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Description
本出願はその特許の全体を本明細書に参考として組み込まれる2013年3月19日に出願された米国仮特許出願第61/803,451号に対する優先権を主張する。
本発明はアメリカ国立衛生研究所グラント番号CA153571の下政府サポートに基づいて行われた。政府は本発明に対して一部の権利を有する。
本願明細書は、例えば、以下の項目も提供する。
(項目1)
組織酸素化の測定のために再発光プローブを検知するように構成された外科用装置は、
再発光プローブの吸収帯内で再発光プローブを励起するように構成された最低1つの光エミッタ、
プローブから再発光される光を受信するように構成された最低1つの光ディテクタ、および
受信した光に基づいて組織酸素化の測定ために構成された信号プロセッサで構成される。
(項目2)
項目1に記載の外科用装置は、更に再発光プローブを含む媒体を標的組織に提供するように構成されたアプリケータで構成される。
(項目3)
項目1に記載の外科用装置では、信号プロセッサが再発光プローブの寿命に基づいて組織酸素化の測定のために構成される。
(項目4)
項目1に記載の外科用装置は、外科用ステイプラーのアンビルである。
(項目5)
項目2に記載の外科用装置では、アプリケータは媒体を標的組織に注入するように構成された最低1つのインジェクタである。
(項目6)
項目1に記載の外科用装置は、更に組織を測定するように構成されたインテロゲータで構成される。
(項目7)
項目1に記載の外科用装置は、表面とインターフェースする組織を有するフレキシブルなサブストレートである。
(項目8)
項目1に記載の外科用装置では、信号プロセッサが組織酸素化の測定に基づいて運用の成否を決定する。
(項目9)
項目1に記載の外科用装置は、更に組織の温度を検出するように構成された温度センサーで構成される。
(項目10)
項目1に記載の外科用装置は、更に圧縮圧および組織間緊張組織の最低1つの相互作用力を監視するように構成された最低1つのセンサーで構成される。
(項目11)
項目1に記載の外科用装置では、プローブは多重吸収波長を有するリン光性プローブである。
(項目12)
項目1に記載の外科用装置は、基地局に通信可能に接続される。
(項目13)
組織酸素化の測定のために再発光プローブを検知するように構成された外科用ステイプラーのアンビル構成は、
再発光プローブを励起するように構成された最低1つの光エミッタ、
プローブから再発光される光を受信するように構成された最低1つの光ディテクタ、および
受信した光に基づいて組織酸素化の測定ために構成された信号プロセッサで構成される。
(項目14)
項目13に記載の外科用ステイプラーのアンビルは、基地局に通信可能に接続される。
(項目15)
項目13に記載の外科用ステイプラーのアンビルでは、信号プロセッサが組織酸素化の測定に基づいて運用の成否を決定する。
(項目16)
項目13に記載の外科用ステイプラーのアンビルは、更に組織の温度を検出するように構成された温度センサーで構成される。
(項目17)
項目13に記載の外科用ステイプラーのアンビルは、更に圧縮圧および組織間緊張組織の最低1つの相互作用力を監視するように構成された最低1つのセンサーで構成される。
(項目18)
組織酸素化の測定のために再発光プローブを検知するように構成された監視装置は、
表面とインターフェースする組織を有するフレキシブルなサブストレート、表面とインターフェースする組織((1)再発光プローブを励起するように構成された最低1つの光エミッタ、および(2)プローブから再発光される光を受信するように構成された最低1つの光ディテクタ、および
受信した光に基づいて組織酸素化の測定ために構成された信号プロセッサを含む)で構成される。
(項目19)
項目18に記載の監視装置は媒体を標的組織に注入するように構成された最低1つのインジェクタ、再発光プローブを含む媒体で構成される。
(項目20)
項目18に記載の監視装置は、基地局に通信可能に接続される。
(項目21)
項目18に記載の監視装置では、信号プロセッサが組織酸素化の測定に基づいて運用の成否を決定する。
(項目22)
項目18に記載の監視装置は、更に組織の温度を検出するように構成された温度センサーで構成される。
(項目23)
項目18に記載の監視装置では、フレキシブルなサブストレートが(1)皮膚に貼り付け(2)内部組織に貼り付けの1つ以上で構成される。
(項目24)
項目18に記載の監視装置は、少なくとも部分的に生体吸収性がある。
(項目25)
再発光プローブを含む組織酸素化をマッピングするように構成された監視装置は、
再発光プローブを励起するように構成された最低1つの光エミッタ、
プローブから再発光される光を受信するように構成された最低1つの光ディテクタ、および
酸素マップを生成するために多点で組織酸素化の測定ために構成された信号プロセッサで構成される。
(項目26)
項目25に記載の監視装置は媒体を標的組織に注入するように構成された最低1つのインジェクタ、再発光プローブを含む媒体で構成される。
(項目27)
項目25に記載の監視装置は、更に組織の温度を検出するように構成された温度センサーで構成される。
(項目28)
項目25に記載の監視装置では、光ディテクタはCCDアレイの最低1つ、CMOS画像センサーおよび1台のカメラで構成される。
(項目29)
項目25に記載の監視装置は、内視鏡装置である。
(項目30)
項目25に記載の監視装置は、摂取可能である。
各外科的処置は失敗する可能性がある。胃腸の手術における一般的な処置は腸切除である − 腸の患部を切除し、残りのセグメントの両端を機械的に接合し、腸の連続性を再確立する。腸の自由端の機械的接続はいわゆる外科的吻合を形成する。外科的吻合は縫合材を使用する従来の技術または外科用ステイプラーまたはその他の外科用固定装置の利用を含む現代の技術のいずれかによって形成される。外科用ステイプラーはカートリッジまたはハウジングから、反対側の固定クリンプを最終的に形成するアンビルに対して腸の2つの自由端を通してステイプラーのパターンを発射して腸を機械的に接合する。多くの外科用ステイプラーの実施態様がある。線形ステイプラーパターンや環状パターンである。いくつかのステイプラーは組織を切断する機能を持つ。多くのステイプラーはステイプラーのベースと形成されたクリンプの間のギャップを変えることができる。
BOC = ヘモグロビンに結合した酸素 + 溶解酸素
BOC = 1.34 * Hb * SO2 + 0.003 * PO2
図4bは、修正済み外科用ステイプラーのアンビル420の作業表面に面する切り抜き422に組み入れられた検知素子を使用した現発明の1つの代表的な構成である。1つの実施態様では、アンビル420は、制御回路430へのフレキシブルケーブル経由でセンサー素子インターフェース回路426に連結する。制御回路430はセンサー素子の制御と解釈用のプロセッサを含むことができる。制御回路は無線トランシーバ432経由で通信できる。装置はバッテリー436で電源を得る。すべてのコンポーネントがシェル、キャップまたはカバー438内に含まれる。
図4cはさらに光学446および機械的検知素子がステイプルフォーム442間のアンビルの面441内の空洞に統合されている1つの実施態様を詳述している。444はアンビルの表面442上の圧縮圧力を測定する圧力変換器のような機械的センサーを表す。445は統合された温度センサーを表す。446と447は光学センサー素子を表すが、446は1つ以上の光エミッタであり、447は1つの光ディテクタである。1つの実施態様では、光学センサー素子は深さ分解検知を有効にするように複数のピーク波長での多重光エミッタを含む。センサー素子444−447は表面441中でともに結合されたまたは分布されたものを含むさまざまな構成における空洞内に見つかる。カバーリップ448はセンサー素子のエッジを取り囲む。1つの実施態様では、検知コンポーネントは、外科用ステイプラーのアンビル、またはその代わりにステイプラーボディまたは他のコンポーネントに連結するシェルに取り込まれる。別の実施態様では、検知コンポーネントは、外科用ステイプラーのアンビルに直接取り込まれ、従来の非検知アンビルに置き換わる。いずれの場合も、検知シェルまたは交換アンビルは、外科用ステイプラーへのアクセサリーまたは付属物として役立ち、オプションとしてステイプラーに連結できる。検知アンビルはスタンドアロン装置として使用することもできるし、またはインテロゲータのような追加装置と結合して使用できる。
図11に示す技術は、他の外科用装置に直接適用される。1つの実施態様では、装置1101は外科用ステイプラーのアンビルである。アンビルはステイプルフォームを組み込んだ顔面1119を持つ。検知素子1127および1129は、表面1119の組織接触面にあるように構成される。ニードル1137はアンビル表面1119、対向面、または内部の空洞に統合してもよい。1つの構成では、リザーバ1143はアンビルの空洞内部に収容され、プランジャー1149はアンビルが対向面に対して組織を圧縮するように作動される。このようにしてステイプラーが閉じると、媒体1143を組織に注入し、アンビルはステイプラー本体の対向面に対して組織を圧縮する。1つの構成では、媒体1143は、アンビルと対向面との間に配置された別の装置のリザーバに含まれる。この構成では、リザーバは圧縮され、アンビルが組織を圧縮すると組織に媒体を排出する。本発明は、注入装置が検知装置内に含まれた上述の実施態様の構成、およびインジェクタが検知装置の外部にあり、独立して操作されていてもよい構成を含む
図3に示す酸素イメージングシステムの例示的な実施態様(すなわち、酸素のマッピングシステム)は構成例であり、このアプローチは、他の器官系に対する他の構成で利用できる。更に好適な実施態様では、このアプローチは胃腸組織の酸素化を評価するために利用される。これはCRC手術の前、最中、後の酸素化を測定するために、前述のアプローチで利用できる。
Claims (17)
- 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記注入可能なプローブは、温度に関して変動する消光定数を有し、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記信号プロセッサ(189,470)は、前記受信された光(181)の測定信号に基づいて組織酸素化のスペクトルを生成するように構成されている、監視装置。 - 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)の時間応答を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記監視装置は、標的組織(954)に媒体(165,950)を提供するように構成されたアプリケータ(157,956)をさらに備え、前記媒体は、前記注入可能なプローブを含む、監視装置。 - 前記信号プロセッサ(189,430,470,705)は、前記再放射された光の寿命に基づいて前記組織酸素化を解明するように構成されている、請求項1および2のうちのいずれかに記載の監視装置。
- 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)の時間応答を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記アプリケータ(474)は、媒体(165)を標的組織(151)中に注入するように構成されている少なくとも1つのインジェクタ(167,478,511,809,1149)である、監視装置。 - 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)の時間応答を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記監視装置は、前記組織(203,1007,1315)を調査するように構成されているインテロゲータ装置(201,301,1001,1101,1331)をさらに備える、監視装置。 - 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)の時間応答を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記信号プロセッサ(189,430,470)は、前記組織酸素化の解明に基づいて動作成功の決定を行う、監視装置。 - 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)の時間応答を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記監視装置は、前記組織の圧縮圧力および組織張力のうちの少なくとも1つの相互作用力を監視するように構成された少なくとも1つのセンサー(113,444,464,1117)をさらに備える、監視装置。 - 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)の時間応答を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記監視装置は、組織インターフェースする表面を有するフレキシブルなサブストレート(605,701)をさらに備え、前記組織インターフェースする表面は、前記少なくとも1つの光学エミッタと、前記少なくとも1つの光学ディテクタ(705)とを含む、監視装置。 - 前記信号プロセッサは、複数のポイント(110,112,405,513,705,1127,1129,1331,1351)における前記再放射された光の前記分析に基づいて前記組織酸素化を解明して、酸素マップを生成するように構成されている、請求項1〜8のうちのいずれかに記載の監視装置。
- 前記監視装置は、内視鏡装置(501,1331)である、請求項1〜9のうちのいずれかに記載の監視装置。
- 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)の時間応答を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記監視装置は、摂取可能である、監視装置。 - 前記監視装置は、外科用装置(101,155,201,301,401,450,501,605,1001,1101,1201,1331)である、請求項1〜9のうちのいずれかに記載の監視装置。
- 組織の組織酸素化を解明するために、光を再放射する注入可能なプローブ(118,153)を検知するように構成された監視装置(101,155,201,301,401,450,501,605,701,1001,1101,1201,1331,1351)であって、前記監視装置は、
前記注入可能なプローブを励起させるように構成されている少なくとも1つの光学エミッタ(173,1127)と、
前記注入可能なプローブから再放射された光を受信するように構成された少なくとも1つの光学ディテクタ(185,1129)と、
前記受信された光(181)の時間応答を分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている信号プロセッサ(189,430,470)と、
前記組織の温度を検出するように構成されているセンサー(445)と
を備え、
前記信号プロセッサ(189,470)は、前記組織酸素化を校正するために前記組織の前記検出された温度を利用するように構成されており、
前記監視装置は、外科用ステイプラーアンビル(401,450)である、監視装置。 - 前記少なくとも1つの光学エミッタ(173)は、前記注入可能なプローブの吸収帯内において前記注入可能なプローブを励起させるように構成されている、請求項1〜13のうちのいずれかに記載の監視装置。
- 前記信号プロセッサ(189,470)は、前記受信された光の酸素依存性光学応答に基づいて前記組織酸素化を解明するように構成されている、請求項1〜14のうちのいずれかに記載の監視装置。
- 前記監視装置は、解明された組織データを外部に通信するように構成され、前記監視装置は、
ディスプレイ(127)および感覚代行のうちの少なくとも1つと、
前記ディスプレイ(127)および感覚代行のうちの前記少なくとも1つと通信するように構成された外部インターフェース(125)と
をさらに備え、
前記信号プロセッサ(189,470)は、前記ディスプレイおよび感覚代行のうちの前記少なくとも1つに、解明され校正された酸素測定を通信するようにさらに構成されている、請求項1〜15のうちのいずれかに記載の監視装置。 - 前記信号プロセッサ(189,430,470)は、前記受信された光(181)の時間応答および前記受信された光(181)の周波数応答のうちの少なくとも1つを分析することによって前記組織の少なくとも1つのポイントの前記組織酸素化の解を得るように構成されている、請求項1に記載の監視装置。
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JP6781807B2 (ja) | 2020-11-04 |
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US20210338121A1 (en) | 2021-11-04 |
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