JPH03111039A - Laser medical treatment device - Google Patents

Abstract

PURPOSE:To prevent a healthy living body tissue from being damaged and to improve the safety by transmitting plural inspecting laser light of different wavelength to a lesser guide and detecting a reflected light from the part to be irradiated, discriminating normal and abnormal tissues, and emitting a laser light for a medical treatment only at the time when an abnormal tissue is detected. CONSTITUTION:A laser light for a medical treatment from a medical treatment laser oscillating device 4, a first inspecting laser light from a blue laser oscillating device 5, and a second inspecting laser light from a red laser oscillating device 6 are reflected by mirrors 8, 9 and 10, respectively and transmit to a laser guide in a laser probe body 1. A first inspecting laser light irradiates the part to be irradiated, for instance, a thrombus B in a blood vessel A, etc., from the tip chip 2, a reflected light is transmitted to a first laser light detecting part 13, and a second inspecting laser light is transmitted to a second laser light detecting part 15 in the same way. Based on a result of detection, a normal tissue and an abnormal tissue are discriminated and only at the time when the abnormal tissue is detected, a laser light for a medical treatment is emitted, therefore, it is prevented that the laser light for a medical treatment irradiates a normal living body tissue and damage of a healthy living body tissue except an abnormal tissue is prevented, and the safety can be improved.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Application Field] The present invention relates to an improvement in a laser treatment device that performs treatment such as cauterization of abnormal tissue in a biological tissue by irradiating the same with laser light.

[Prior Art] Generally, as a laser treatment device, for example, Japanese Patent Application Laid-Open No. 1-135
As shown in Japanese Patent No. 368, a configuration is known in which a laser beam emitted from a laser oscillation device is irradiated onto an irradiated area formed by an affected area such as a tumor area through a laser guide of a laser probe. In this case, the laser treatment device is provided with two or more types of treatment laser devices having different wavelengths. When irradiating therapeutic laser light, the treatment laser device to be used is selected depending on the size of the affected area such as a tumor, the temperature state of the affected area, etc. It was configured to control the range.

[Problems to be Solved by the Invention] In the above-mentioned conventional structure, the laser beam is applied to the affected area during treatment in which the therapeutic laser beam is irradiated to the affected area, such as a lesion in a blood vessel or a blood clot, to cauterize the area. There was a problem in that it was difficult to accurately determine whether or not irradiation was being performed accurately. Therefore, there is a risk that the therapeutic laser light may be irradiated to normal living tissue other than the abnormal tissue that is the affected part, such as a lesion in a blood vessel or a blood clot. There was a risk that the light would cauterize and cause damage such as making a hole in the living tissue of this normal blood vessel.

This invention was made in view of the above circumstances, and it is possible to accurately determine whether or not abnormal tissue such as an affected area is being irradiated with laser light, and to apply therapeutic laser light to normal biological tissue. It is an object of the present invention to provide a laser treatment device that can prevent damage to healthy living tissues other than abnormal tissues by preventing irradiation of the laser beam, thereby improving safety.

[Means for Solving the Problems] The present invention provides a laser beam guiding means for guiding a therapeutic laser beam and a plurality of inspection laser beams having different wavelengths to the same laser guide, and also Emission of therapeutic laser light that detects the reflected light of each inspection laser light, distinguishes between normal tissue and abnormal tissue based on these detection results, and emits therapeutic laser light only when abnormal tissue is detected. A control means is provided.

[Operation] During treatment with laser light, multiple inspection laser beams with different wavelengths are guided to the same laser guide, the reflected light of each inspection laser beam from the irradiated area is detected, and the detection results are By distinguishing between normal tissue and abnormal tissue based on the above information, and emitting therapeutic laser light only when abnormal tissue is detected, it is possible to prevent normal biological tissue from being irradiated with therapeutic laser light and detect abnormal tissue. This is designed to prevent damage to healthy biological tissues other than tissues and improve safety.

[Embodiment] A first embodiment of the present invention will be described below with reference to FIGS. 1 to 3. FIG. 1 shows a schematic configuration of the entire laser treatment device, and 1 is a laser probe main body. A laser guide for guiding laser light formed by an optical fiber (not shown) for guiding laser light is disposed within the laser probe main body 1. As shown in FIG. This light guiding laser guide is covered by a protective tube. Furthermore, a translucent tip 2 for irradiating laser light is disposed at the tip of the laser probe body 1.

Further, the base end portion of the laser guide within the laser probe main body 1 is connected to the laser device 3. Inside this laser device 3, there is a therapeutic laser oscillation device 4 that generates a therapeutic laser beam for cauterization, etc., and a blue laser oscillation device 5 and a red laser oscillation device that generate a plurality of inspection laser beams having different wavelengths, for example. 6 are provided respectively. In this case, the therapeutic laser oscillation device 4 is formed by, for example, a YAG laser device, the blue laser oscillation device 5 is formed by, for example, an Ar laser device, and the red laser oscillation bag flf6 is formed by, for example, an H
They are each formed by an e-Ne laser device.

Furthermore, inside this laser device 3, the treatment laser beam from the treatment laser oscillation device 4 and the plurality of inspection laser beams having different wavelengths from the blue laser oscillation device 5 and the red laser oscillation device 6 are integrated into the same system. A laser beam guide means 7 is provided to guide the light to the laser guide. This laser beam guide means 7 includes first laser guides arranged in parallel at appropriate intervals on the optical axis of the laser guide in the laser probe body 1. Second. A third respective mirror 8, 9, 10 is provided.

The first of these. Second. Each of the third mirrors 8°9.10 is installed at an inclination angle of 45'' with respect to the optical axis direction of the laser guide in the laser probe main body 1. The laser beam for
The first inspection laser beam emitted from the blue laser oscillation device 5 is reflected by the second mirror 9 and guided to the laser guide in the laser probe main body 1. The second inspection laser beam emitted from the red laser oscillation device 6 is reflected by the third mirror 10 and guided to the laser guide in the laser probe body 1. The light is guided by a guide. Note that the second mirror 9 is formed of, for example, a blue dichroic mirror, and the third mirror 10 is formed of a red dichroic mirror.

Furthermore, half mirrors 11 and 12 are interposed between the second mirror 9 and the blue laser oscillation device 5 and between the third mirror 10 and the red laser oscillation device 6, respectively.

In this case, a first laser light detection section 13 is disposed on one half mirror 11 and a second laser light detection section 15 is disposed on the other half mirror 12 with a YAG cut filter 14 in between. When the first inspection laser beam is emitted from the blue laser oscillation device 5, this first inspection laser beam is guided to the laser guide in the laser probe main body 1, and from the distal tip 2, for example, inside the blood vessel A. After irradiating the irradiated part such as the thrombus B, the reflected light of the first inspection laser beam from the irradiated part is transmitted to the laser probe body 1.
laser guide inside, second mirror 9, half mirror 11
The reflected light of the first inspection laser beam from the irradiated area is detected by the first laser beam detection section 13. It is now possible to do so. Furthermore, when the second inspection laser beam is emitted from the red laser oscillation device 6, this second inspection laser beam is similarly guided to the laser guide in the laser probe main body 1, and from the tip tip 2 to the irradiated area. After that, the reflected light of the second inspection laser light from this irradiated part passes through the laser guide in the laser probe main body 1, the third mirror 10, the half mirror 12, and the YAG cut filter 14 in order. The light is guided to a second laser light detection section 15, and this second laser light detection section 1
5 detects the reflected light of the second inspection laser beam from the irradiated portion. In this case, the reflectance (light amount or W amount) of the reflected light of each inspection laser beam from the irradiated area is as shown in Figure 2. It has been confirmed that the case is different.

Further, the first laser beam detection section 13 includes a first comparator 16.
is connected. A first set value circuit 17 is connected to the first comparator 16 .

In this case, the first set value circuit 17 outputs, for example, a first set value signal corresponding to the reflectance range of the reflected light of the first inspection laser beam from normal living tissue. There is. Furthermore, the first comparator 16 is connected to a control section (emission control means) 18 that is connected to the therapeutic laser oscillation device 4 . This control section 18 is formed by, for example, a microcomputer and its peripheral circuits. The output signal from the first comparator 16 is input to the control section 18.

Further, the second laser beam detection section 15 includes a second comparator 19.
is connected. A second set value circuit 20 is connected to one of the second comparators.

In this case, the second set value circuit 20 outputs, for example, a first set value signal corresponding to the reflectance range of the reflected light of the second inspection laser beam from normal living tissue. There is. Furthermore, this second comparator 20 is also connected to the control section 18, and the output signal from this second comparator 20 is input to this control section 18.

Note that the first laser beam detection section 13 and the second laser beam detection section 15 are each connected to a display section 21, and the first laser beam detection section 13 and the second laser beam detection section 15 are connected to the display section 21. The detection value of the reflectance of the reflected light of each inspection laser beam by the section 15 is displayed.

On the other hand, FIG. 3 shows a schematic configuration of the therapeutic laser oscillation device 4. As shown in FIG. In this Figure 3, 22 is a YAG rod,
23 is an excitation lamp arranged near this YAG rod 22, 24 is a power source for this excitation lamp 23, and 25 is a Y
A partially transmitting mirror 26 disposed at one end of the AG rod 22 is a total reflection mirror disposed at the other end of the YAG rod 22 . In this case, a YAG shutter 27 for opening and closing is provided between the YAG rod 22 and the partially transparent mirror 25. The YAG shutter 27 controls the generation of therapeutic laser light from the therapeutic laser oscillation device 4. Furthermore, this YAG
The shutter 27 is connected to the control section 18. and,
In the control unit 18, the first comparator 16 and the second comparator 1
Based on the output signal from the laser probe body 1, the first laser beam is actually irradiated from the tip 2 through the laser guide in the laser probe main body 1. The type of the area to be irradiated with each of the second inspection laser beams (normal tissue or abnormal tissue) is determined, and the YAG shutter 27 is opened only when abnormal tissue is detected, so that the therapeutic laser oscillator 4 can be used for treatment. The therapeutic laser oscillation device 4 is controlled to emit laser light.

Next, the operation of the above configuration will be explained.

When using this laser treatment device, the laser probe body 1 is inserted in advance into a treatment target site such as inside a blood vessel A, and the distal tip 2 of this laser probe body 1 is placed opposite to the irradiated part such as a thrombus B in the blood vessel A. .

In this situation, the blue laser oscillation device ft5 and the red laser oscillation device 6 generate the first inspection laser beam and the second inspection laser beam, respectively, and each of these inspection laser beams is connected to the same laser beam. The light is guided through a laser guide within the probe body 1 and irradiated onto a target portion, such as a thrombus B within a blood vessel A, for example. In this case, the first inspection laser beam from the irradiated section is guided to the first laser beam detection section 13 through the laser guide in the laser probe body 1, the second mirror 9, and the half mirror 11 in this order. , this first laser light detection section 1
3, the reflected light of the first inspection laser beam from the irradiated portion is detected. Furthermore, the reflected light of the second inspection laser beam from the irradiated part passes through the laser guide in the laser probe main body 1, the third mirror 10, the half mirror 12, and the YAG cut filter 14 in order, and becomes the second laser beam. Detection part 1
5, and this second laser light detection section 15 detects the reflected light of the second inspection laser light from the irradiated part.

Furthermore, the detection values from the first laser light detection section 13 and the second laser light detection section 15 are transmitted to each set value circuit 17, 20 by the first comparator 16 and the second comparator 19.
The output signal is compared with the set value signal from the controller 1.
8 is input. Then, the control unit 18 controls the therapeutic laser oscillation device 4 based on the output signals from the first comparator 16 and the second comparator 19. In this case, the control unit 18 actually determines the type of area to be irradiated (normal tissue or abnormal tissue) by the first and second inspection laser beams irradiated from the distal tip 2 through the laser guide in the laser probe body 1. ), and the YAG shutter 2 is activated only when abnormal tissue is detected.
7 is opened to emit therapeutic laser light from the therapeutic laser oscillation device 4.

Therefore, in the above configuration, before emitting the therapeutic laser beam from the therapeutic laser oscillating device 4, a plurality of inspection laser beams having different wavelengths (the first laser beam emitted from the blue laser oscillating device 5) is used. The inspection laser beam and the second inspection laser beam emitted from the red laser oscillation device 6 are guided to the laser guide in the same laser probe main body 1 to illuminate the irradiated area, such as a thrombus B in a blood vessel A. The reflected light of each examination laser beam is detected respectively, and based on these detection results, normal tissue and abnormal tissue are distinguished. Since light is emitted, it is possible to prevent normal living tissue from being irradiated with therapeutic laser light. Therefore, it is possible to prevent damage to healthy biological tissues other than abnormal tissue such as thrombus B in blood vessel A, and it is possible to improve safety. In addition, since a plurality of inspection laser beams having different wavelengths are used to measure the area to be irradiated, such as a thrombus B in blood vessel A, it is difficult to accurately measure the irradiated area using one of the inspection laser beams. Even if the irradiated area is measured using the other inspection laser beam, the irradiated area can be measured more accurately than when the irradiated area is measured using a single wavelength inspection laser beam. .

In the above embodiment, the configuration is shown in which the YAG shutter 27 is opened and closed to control the emission of therapeutic laser light from the therapeutic laser oscillation device 4; The configuration may be such that the emission of therapeutic laser light from the therapeutic laser oscillation device 4 is controlled.

Further, FIG. 4 shows a second embodiment of the present invention.

This is a coating film (cladding) that covers the laser guide 31 in the laser probe body 1 with the quartz core 32 and its surroundings.
33, and a pair of ring-shaped metal indicators 34 and 35 are attached to the outer circumferential surface of the tip of this coating film 33. In this case, the tip of the quartz core 32 is connected to the coating film 33.
Extends outward from the tip of the moreover,
A pair of metal indicators 34 and 35 are arranged at a predetermined interval. In this case, for example, the first metal indicator 34 on the tip side
and the tip end surface (output end surface) of the quartz core 32 is f.
If set to ll, the first . The spacing g2 between the second metal indicators 34.35 is set to fiz-n+.

Therefore, in this case, for example, when using the laser probe body 1 under X-ray fluoroscopy, by confirming the positions of the pair of metal indicators 34 and 35 that can be confirmed in the X-ray image,
Quartz core 32 of laser guide 31 that cannot be seen in the X-ray image
The position of the output end face of the tip can be accurately confirmed based on the positional relationship with these metal indicators 34 and 35.

Furthermore, in this case, the laser beam may be absorbed by the metal indicator as in the case where a metal indicator is attached to the tip face (output end face) of the quartz core 32, or the metal indicator may fall off if the quartz core 32 melts. can be reliably prevented.

Note that the distance between the first metal indicator 34 on the tip side and the tip surface (output end surface) of the quartz core 32 is gl and the first metal index on both sides.
．． The distance fI2 between the second metal indicators 34.35 is 1l-R
It is not limited to z, but jl 1−xRz (
x may be any number).

Further, the metal indicators 34 and 35 of the second embodiment may be formed by a single metal indicator cylinder 36 as in a third embodiment of the invention shown in FIG. In this case, the metal indicator tube 3
The length dimension g2 of 6 is flx-! It may be lx or fIt-xj! z (x is any number).

Further, FIGS. 6 to 8 show a fourth embodiment of the present invention.

In this case, the laser guide 43 disposed within the sheath 42 of the laser probe main body 41 is formed of a quartz core 44 and a coating film (cladding) 45 surrounding the quartz core 44, as in the second embodiment. This laser probe body 4
1, a bending operation mechanism is provided at the tip. In this case, a fixture 46 is attached to the distal end of the sheath 42 of the laser probe body 41, and the distal end of the laser guide 43 is fixed to the distal end of the sheath 42 by this fixture 46. In addition, a pair of angle wire insertion holes 4 are provided in the cylindrical wall at the tip of the sheath 42 of the laser probe body 41.
7 and 48 are formed at appropriate intervals along the axial direction. Further, an angle wire 49 is inserted into the sheath 42 so as to be freely advanced and retracted. The tip of this angle wire 49 is connected to the angle wire insertion hole 48 on the rear end side.
This lead-out end is further introduced into the inside of the sheath 42 through the angle wire insertion hole 47 on the distal side, and this introduced end connects the fixture 46 and the distal end of the sheath 42. It is fixed in the inserted state between. By moving the angle wire 49 forward and backward along the axial direction, the pair of angle wire insertion holes 4 at the tip of the angle wire 49 are opened.
The amount of protrusion of the portion guided to the outside between 7 and 48 can be adjusted as appropriate, and the protruding portion of the angle wire 49 presses, for example, the inner wall of the blood vessel A to bend the tip of the laser probe body 41. A bending operation mechanism section is formed to allow the bending operation to be performed.

Therefore, in the case of the above structure, the angle wire 49
By moving the angle wire 49 forward and backward along the axial direction, the amount of protrusion of the portion led out to the outside between the pair of angle wire insertion holes 47 and 48 at the tip of the angle wire 49 is changed, and the protrusion of the angle wire 49 is changed. For example, the inner wall of the blood vessel A is pressed by the portion of the laser probe main body 4.
Since the bending operation mechanism section for bending the tip of the laser probe body 41 is formed, the bending operation mechanism section can be formed with a relatively simple configuration, and the outer diameter of the tip of the laser probe main body 41 can be prevented from increasing. can do.

Further, FIG. 9 and FIG. 1O show a fifth embodiment of the present invention.

The sheath 42 of the laser probe main body 41 of the fourth embodiment is formed by a multi-lumen tube in which a plurality of holes are formed in a single tube extending in the axial direction. laser guide 43 in the center hole of
At the same time, the angle wires 49 of the fourth embodiment are respectively arranged in the wire insertion holes arranged at equal intervals at four places in the circumferential direction of this sheath 42, and these four angle wires 49a A bending operation mechanism section for bending the laser probe main body 41 in four directions by means of .about.49d is provided. In this case, each angle wire 49a to 4
The bending operation mechanism of the laser probe main body 41 according to 9d is the same as that of the fourth embodiment.

Therefore, in this case, the bending operation direction of the laser probe main body 41 can be adjusted more accurately than in the fourth embodiment.

It should be noted that this invention is not limited to the above-mentioned embodiments, and it goes without saying that various modifications can be made without departing from the gist of the invention.

[Effects of the Invention] According to the present invention, a laser beam guide means is provided for guiding a therapeutic laser beam and a plurality of inspection laser beams having different wavelengths to the same laser guide, and Emission control of therapeutic laser light that detects each reflected light of the inspection laser light, distinguishes between normal tissue and abnormal tissue based on these detection results, and emits therapeutic laser light only when abnormal tissue is detected. By providing a means, it is possible to accurately determine whether or not abnormal tissue such as an affected area is being irradiated with laser light, and it is possible to prevent irradiation of therapeutic laser light to normal biological tissue. It is possible to prevent damage to healthy living tissues other than abnormal tissues and improve safety.

[Brief explanation of drawings]

1 to 3 show a first embodiment of the present invention, in which FIG. 1 is a schematic diagram of the overall configuration, FIG. 2 is a characteristic diagram showing detection results using an inspection laser beam, and FIG. is a schematic configuration diagram of a therapeutic laser oscillation device, FIG. 4 is a longitudinal sectional view of the main part showing the second embodiment, FIG. 5 is a longitudinal sectional view of the main part showing the third embodiment, and FIG. 8 to 8 show a fourth embodiment of the present invention, FIG. 6 is a perspective view of the main part, FIG. 7 is a vertical sectional view of the same, and FIG. 8 is a schematic configuration of the main part showing the state of use. 9 and 10 show the fifth embodiment, in which FIG. 9 is a perspective view of the main part, and FIG. 10 is a sectional view taken along the line X--X in FIG. 9. 4... Laser oscillation device for treatment, 5... Blue laser oscillation device (laser light oscillation device for inspection), 6... Red laser oscillation device (laser light oscillation device for inspection), 7... Laser light guide Optical means, 13...first laser light detection section, 15
. . . second laser light detection section, 18 . . . control section (emission control means).

Claims (1)

[Claims] In a laser treatment device that irradiates a laser beam emitted from a laser oscillation device to an irradiated area via a laser guide,
A laser beam guiding means is provided for guiding a therapeutic laser beam and a plurality of inspection laser beams having different wavelengths from each other to the same laser guide, and the reflected light of each of the inspection laser beams from the irradiated portion is provided. The present invention is characterized by being provided with a therapeutic laser beam emission control means for detecting each of the above, discriminating between normal tissue and abnormal tissue based on these detection results, and emitting the therapeutic laser beam only when abnormal tissue is detected. Laser treatment equipment.