JP2004089533A - Fluorescent substance accumulating tumor boundary identification device - Google Patents

Abstract

An object of the present invention is to assist in performing safer tumor excision without disturbing a surgical procedure and accurately identifying a tumor region.
Kind Code: A1 An excitation light of a predetermined wavelength component is radiated to a fluorescent substance which has been accumulated on an affected part OB of a patient PS and has undergone chemical modification, and excitation of the fluorescent substance is intermittently performed by repeatedly turning on and off the fluorescent substance. A light source unit 2, an optical fiber 8 for guiding excitation light from the light source unit 2 to the vicinity of the affected area OB, and receiving fluorescence emitted from a fluorescent substance accumulated in the affected area, and entering through the optical fiber 8. A detecting unit 3 for detecting the intensity of the fluorescent light, an arithmetic unit 4 for estimating the concentration of the fluorescent substance based on the fluorescent intensity corresponding to the turning on and off of the light source unit 2 detected by the detecting unit 3; A display device 5 for displaying the estimated concentration of the fluorescent substance.
[Selection diagram] Fig. 1

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to an apparatus for identifying a boundary of a fluorescent substance-accumulating tumor, and particularly, when performing an operation of surgically resecting a tumor having a fluorescent substance-accumulating property, the boundary of the tumor is illuminated by an operating light or a normal light. However, the present invention relates to an assisting device for assisting a surgical operation for tumor resection by detecting without being affected by the influence and marking the boundary surface thereof. This support device can be used for, for example, brain surgery or general surgery in which the boundary between tumor tissue and normal tissue is very important.
[0002]
[Prior art]
In clinical settings, when the tumor in the affected area has penetrated into the surrounding tissue and the boundary between the tumor tissue and normal tissue is unclear, it is usually a priority to completely remove the tumor tissue, and the resection method including the suspected part is widely adopted. ing. However, unnecessary resection is not desirable. Especially in brain tumors, aggressive treatment was difficult because careless resection could severely damage brain function.
[0003]
Therefore, in the treatment of brain tumors, attempts have been made for brain surgery in which the following normal tissue is identified and only necessary and sufficient portions are excised. In this method, first, a fluorescent substance with tumor accumulation is administered to the patient, and when the accumulation in the tumor has progressed, the fluorescent substance is removed while all operating lights and operating room lighting are turned off. Light of a wavelength that can be excited, for example, only near-ultraviolet light, etc., is applied to the affected area and its surroundings. At this time, by utilizing the characteristic that a region that emits fluorescence by irradiation with near ultraviolet rays (a region where the accumulation of the fluorescent substance is advanced) is a tumor (affected part) region, the tumor region can be distinguished from normal tissue. Visualize and record the information as an image. Thereafter, the lighting is returned to the normal lighting, and the brain surgery of the operator is performed based on the information.
[0004]
As an example of the above-mentioned fluorescent substance having a tumor accumulation property, a fluorescent dye 5-ALA (Aminolevulinic Acid) is known. When 5-ALA is administered, Porphobilinogen is chemically modified to Protoporphyrogenogen IX by the action of an enzyme, which accumulates in cells and emits fluorescence. By applying this phenomenon, it is possible to identify a tumor region by the above method.
[0005]
FIG. 5 shows a conventional tumor boundary discriminating apparatus using 5-ALA as the tumor-accumulating fluorescent substance. Here, the 5-ALA is considered to be a substance naturally generated in a living body, has a small side effect on the human body, and can be administered either orally or intravenously. When 5-ALA is taken into the body, the concentration of porphyrin (Protoporphyrinogen IX) in the cells increases. It is known that the wavelength region of the excitation light for exciting the porphyrin is 370 nm to 380 nm, and the peak of the wavelength region of the fluorescence emitted from the porphyrin by irradiation of the excitation light in the wavelength region is around 620 nm. Since the fluorescence wavelength of this 5-ALA is in the red region and is close to the color of blood, it is often difficult to visually recognize it with the naked eye.
[0006]
Therefore, the conventional tumor boundary identifying apparatus shown in FIG. 5 includes a light source unit that emits excitation light, and a camera unit that detects fluorescence generated by the irradiation of the excitation light, and the light source unit transmits only the excitation wavelength. The filter has a structure in which an optical filter that allows only a fluorescence wavelength to pass is arranged in a camera unit.
[0007]
Specifically, in the conventional example shown in FIG. 5, brain surgery is performed on a patient PS on an operating table to treat a brain tumor (affected area) in an operating room where a normal illumination light 100 and an operating light 110 are placed. It is assumed that it is applied.
[0008]
As shown in the figure, a conventional brain tumor identification apparatus used in this brain surgery performs an excitation for exciting a fluorescent substance (porphyrin) that accumulates in cells around the affected part of a patient PS to which 5-ALA has been administered. An excitation light source 120 for irradiating light of a wavelength (such as near-ultraviolet light), an image (hereinafter, a fluorescent image) showing the distribution of fluorescence emitted from a fluorescent substance accumulated in a tumor region by this excitation light irradiation, and normal visible light An imaging device 130 that captures an image (hereinafter, a visible light image); a control device 140 that controls the operation of the excitation light source 120 and the imaging device 130; and a fluorescent image and a visible light image obtained by the imaging device 130 that are superimposed or displayed. An image synthesizing device 150 that performs image processing such as two-screen display in which one screen is divided into two and individually displayed, and an image processed by the image synthesizing device 150 is displayed. And a display device 160.
[0009]
Among them, the excitation light source 120 provided white light from a white light source 122 such as a halogen lamp or a metal halide lamp provided in the light source main body 121 on its optical path in order to irradiate only the light of the excitation wavelength to the vicinity of the affected part. The light having the above-described excitation wavelength is passed through the lens system 123 and the optical filter 124, and the excitation light is guided to a predetermined position near the affected part of the patient PS via an optical fiber 125 extending and attached to the outside of the light source main body 121. It has a structure of irradiating near the affected part through a condenser lens 126 attached to the tip of the optical fiber 125.
[0010]
The imaging device 130 has two types of cameras, for example, a CCD (charge coupled device) having sensitivity in the visible light wavelength region, so that the vicinity of the affected part of the patient PS can be imaged from the same viewpoint in a stand-type device main body 131, for example. A camera 132 for visible light, such as a camera, and a camera 133 for fluorescence, such as a CCD camera or a CCD camera with an optical filter, having sensitivity in the wavelength region of the fluorescent light emitted by the fluorescent substance are arranged. It has a structure that can be switched between each other via a switching mirror 134 such as a mechanical movable mirror or a half mirror provided on the side. If the images need not be viewed from the same viewpoint, the two types of cameras 132 and 133 are arranged so as to see substantially the same affected area. In this case, the fluorescence image and the visible light image obtained by the imaging device 130 are obtained. Are not strictly overlapped with each other, they are displayed individually on a two-screen display instead of being superimposed on the display device.
[0011]
According to the above-described conventional brain tumor identification apparatus, first, the tumor-integrating fluorescent substance administered to the patient PS in a state where the interior lighting lamp 100 and the surgical light 110 in the operating room are turned off and the excitation light source 120 is turned on. An image near the affected part (hereinafter, a fluorescent image) showing the distribution of 5-ALA is captured by the fluorescent camera 133 of the imaging device 120 and recorded in the image synthesizing device 150.
[0012]
Next, the excitation light source 120 is turned off, the indoor lighting lamp 100 is turned on, an image of the vicinity of the affected part, which is projected under normal visible light, is captured by the visible light camera 132 of the imaging device 120, and the display device 160 is displayed in real time. Display above. At this time, the image showing the distribution of 5-ALA recorded above according to the operator's request is superimposed on the image obtained by visible light on the display device 160, or the visible light is displayed by two-screen display. It is displayed together with the image as its reference image.
[0013]
The operator removes only the necessary and sufficient affected part while referring to these display images. When the affected part is deformed by this excision, the operation is advanced by finely repeating the above-described cycle of capturing the fluorescent image → capturing the visible light image → superimposed display or two-screen display.
[0014]
[Problems to be solved by the invention]
However, in the above-described conventional brain tumor identification apparatus, it is necessary to repeatedly turn on / off the indoor illumination lamp and turn off / on the excitation light source for each operation, and there is an advantage that the entire image of the tumor region can be grasped. There is a problem that complicated work occurs.
[0015]
That is, the above-described conventional method is suitable for visualizing the entire region of the tumor, but in order to proceed with the surgical operation, it is absolutely necessary to return to normal illumination, such as an operating light, and to proceed with the operation. Since the deformation of the affected part progresses, there is a trouble that this procedure must be repeated.
[0016]
In order to take advantage of surgery in this tumor area, the affected part that emits fluorescence under near-ultraviolet light is once photographed and recorded with a CCD camera or the like that is sensitive to the fluorescence wavelength, and the still image is returned to normal illumination when visible light is applied. A method of superimposing and displaying a moving image captured by a CCD camera having sensitivity in an area is adopted. However, as the operation proceeds, the affected part is deformed, so that this procedure needs to be repeated frequently, which has led to a complicated apparatus and complicated work.
[0017]
The present invention has been made in view of such a conventional situation, and has been made to enable safer tumor resection without disturbing a surgical procedure and accurately identifying a tumor region. The purpose is to support.
[0018]
[Means for Solving the Problems]
In order to achieve the above object, according to the present invention, as a boundary discriminating apparatus for a fluorescent substance-accumulating tumor, for example, a mechanism capable of lighting for an arbitrary time, for example, a mechanical shutter or the like, and a fluorescent substance having a tumor accumulating property A light source that emits light having a wavelength that excites the substance, a detection unit that detects fluorescence emitted from the fluorescent substance when the light from the light source is irradiated on the affected part, and detects fluorescence from the fluorescent substance in the detection unit. Arithmetic means for estimating a parameter corresponding to the concentration of the fluorescent substance accumulated in the tumor from the optical fiber to be guided and the intensity information of the detected fluorescence and the intensity of the excitation light source in association with the case of being excited and the case of not being excited And a display means for notifying the operator of the result.
[0019]
In this configuration, when the surgeon determines the boundary between the tumor and the normal tissue, it is also possible to provide a dye application means for marking the boundary. It is also possible to keep the distance from the opening of the optical fiber to the surface of the affected part constant and to provide a protection means at the distal end of the optical fiber for preventing the surface of the affected part from being damaged. This protection means can also serve as a nozzle orifice of a nozzle of the dye application means or a suction port of a nozzle of the suction means used for sucking and removing unnecessary liquid.
[0020]
Further, in the present invention, as a boundary discriminating device for a fluorescent substance-integrating tumor, for example, an excitation light source that controls lighting / extinguishing at an arbitrary timing and emits light in a wavelength region that excites the fluorescent substance, and the excitation light source Control means for stabilizing the intensity of light over time, and detection means for separating a specific wavelength from the fluorescence emitted from the affected part and detecting the intensity, such as an optical filter or a diffraction grating, and receiving light by a photodiode or the like. The combination of the sensor, the optical fiber that guides the excitation light from the excitation light source to the affected part surface, and guides the fluorescence emitted from the affected part to the detection means, and the case where the excitation light source is turned on and the case where the excitation light is turned off, respectively. Attention has been paid to a configuration including a calculation / display means for performing a predetermined calculation from information on the fluorescence intensity detected by the detection means and displaying the calculation result.
[0021]
In this configuration, further, in the vicinity of the optical fiber opening, means for protecting the affected part from being damaged, dye applying means for applying a dye to the affected part for marking, and suction for removing unnecessary liquid. A container can be added.
[0022]
According to this configuration, even under normal lighting, if the wire end (opening) of the optical fiber is pressed against the patient surface while maintaining a certain distance, information reflecting the fluorescent substance concentration on the affected surface can be easily obtained. The use of the dye application means makes it possible to easily visualize information on where the boundary is.
[0023]
The apparatus for identifying a boundary of a fluorescent substance-accumulating tumor according to the present invention has been completed based on such an idea.
[0024]
That is, the apparatus for identifying a boundary of a fluorescent substance-accumulating tumor according to the present invention irradiates excitation light of a predetermined wavelength component to a fluorescent substance that has been accumulated in an affected part of a living body and has undergone chemical modification, and is illuminated and turned on. A light source that intermittently excites the fluorescent substance by repeatedly turning off the light, a light guiding unit that guides the excitation light from the light source to the vicinity of the affected part in the living body, and a fluorescent light emitted from the fluorescent substance accumulated in the affected part. Detecting means for detecting the intensity; calculating means for estimating the concentration of the fluorescent substance based on the fluorescent intensity corresponding to turning on and off the light source detected by the detecting means; and the concentration of the fluorescent substance by the calculating means. Display means for displaying the estimated value.
[0025]
In the present invention, the light source is a halogen lamp light source or a metal halide lamp light source having a mechanical shutter and an optical filter that transmits light having a component near a specific wavelength, or has excellent responsiveness of turning on and off the light source. It is preferable that an LED (light emitting diode) or an optical filter is provided for the LED.
[0026]
In addition, the light guide unit may include an optical fiber that guides the excitation light to an affected area where the fluorescent substance accumulates, and guides fluorescence emitted from the fluorescent substance by the excitation light to the detection unit. In this case, it is preferable to provide a condensing microlens at the tip (opening) of the optical fiber in order to prevent the dispersion of the excitation light and ensure the straightness. Further, it is more preferable that the distal end of the optical fiber is constituted by a handpiece.
[0027]
Further, it is preferable that the detection means includes a diffraction grating formed by combining a concave diffraction grating, a convex diffraction grating, or a lens, and a photodetector that converts light into an electric signal. In this case, it is preferable to have a characteristic capable of responding quickly and intermittently to turning on and off the light source.
[0028]
Further, the calculating means sets the measured value at the first wavelength corresponding to the intensity of the excitation light when the light source is turned on to Lon, and sets the measured value at the first wavelength corresponding to the intensity of the excitation light when the light source is turned off. The measured value is Loff, the measured value at a second wavelength different from the first wavelength corresponding to the intensity of the fluorescence detected by the detecting unit when the light source is turned on is lon, and the detecting unit detects when the light source is turned off. When a measured value at a second wavelength different from the first wavelength corresponding to the intensity of the detected fluorescence is defined as loff, and a parameter corresponding to the concentration of the fluorescent substance is defined as P, the parameter P = (lon-loff) / (Lon-Loff) or a numerical value having a monotonic increase or a monotonically decreasing relationship with the parameter P with respect to a change in the parameter P. Door is preferable. According to this, it is possible to estimate a parameter that is substantially proportional to the concentration of the fluorescent substance even when disturbance light exists.
[0029]
Further, in the present invention, there is provided a dye application unit having an opening for applying a dye to the affected part surface estimated by the arithmetic unit and performing marking, and an opening for sucking and removing the liquid on the affected part surface. It is preferable that the optical fiber further includes a suction unit, and the opening of the dye application unit and the opening of the suction unit are arranged at predetermined positions near the tip of the optical fiber. In this case, the tip of the optical fiber is more preferably constituted by a handpiece.
[0030]
Further, in the present invention, it is preferable that the optical fiber further comprises a protection means which is detachably attached to the distal end portion of the optical fiber and has a gently curved shape. Thus, when the distal end portion of the optical fiber is brought into contact with the surface of the affected part, it is possible to prevent the affected part from being damaged by the pressure concentration.
[0031]
BEST MODE FOR CARRYING OUT THE INVENTION
An embodiment of the apparatus for identifying a boundary of a fluorescent substance-accumulating tumor according to the present invention will be described below with reference to the accompanying drawings.
[0032]
The fluorescent substance-accumulating tumor boundary discriminating apparatus shown in FIG. 1 performs a surgical operation for excision of an affected part (tumor such as a brain tumor) OB of a patient PS in an operating room where a normal illumination light 100 and an operating light 110 are installed. At this time, for example, a fluorescent substance having a property of selectively accumulating in the tumor cells around the affected part OB of the patient PS to which the above-mentioned fluorescent dye (eg, 5-ALA) having a tumor accumulating property is administered. Porphyrin) is irradiated with light having an excitation wavelength (for example, near-ultraviolet light having a wavelength of 370 nm to 380 nm) to excite the porphyrin, and fluorescence (for example, a wavelength peak) emitted from the porphyrin by irradiation of the excitation light in that wavelength region. Is applied to a device for identifying the boundary between tumor tissue and normal tissue by detecting near-infrared light near 620 nm.
[0033]
That is, this device includes a light source unit (for example, near-ultraviolet light source) 2 for generating excitation light and a detection unit (for example, for detecting fluorescence) mounted in a boundary identification device main body (hereinafter, “device main body”) 1. A near-infrared detector 3, a computing device 4, a display device 5, a dye coating device 6, a suction device 7 and a waste liquid tank 7 a thereof, and a device extending from the outside of the device body 1 to a position around the affected part OB of the patient PS, An optical fiber 8 connected to the light source unit 2 and the detecting unit 3; a nozzle 6a connected to the dye coating device 6 and a nozzle 7a connected to the suction device 7; An affected-part surface protection device 9 is provided at the distal ends (openings) of the nozzles 6a and 7a.
[0034]
Of these, the tip of the optical fiber 8 is integrated with the nozzle 6a of the dye coating device 6, the nozzle 7a of the suction device 7, and the diseased part surface protection device 9, and is a handpiece having a shape that is easy for the operator to hold by hand. The mold detector (hereinafter, “handpiece”) 10 is configured.
[0035]
The light source unit 2 includes, for example, an excitation light source 21 that generates white light intermittently by repeatedly turning on and off at a controlled timing, and an area near a specific wavelength (for example, near ultraviolet) among the wavelength components of the white light. ), And an optical filter 22 that emits excitation light to the optical fiber 8 as excitation light.
[0036]
Among them, as the excitation light source 21, for example, a white light source such as a halogen lamp or a metal halide lamp having a mechanical shutter whose opening can be freely opened and closed at a controlled timing is applied. However, the present invention is not limited to this. For example, an optical semiconductor such as an LED or a semiconductor laser having a characteristic in which the wavelength matches the excitation light and has a narrow wavelength range is also applicable.
[0037]
The timing of turning on / off the excitation light source 21 is controlled by a controller (not shown) so as to be synchronized. This control may be shared by the arithmetic unit 4 described later. The excitation light generated intermittently from the light source unit 2 is sent to the optical fiber 8.
[0038]
The optical fiber 8 is made of a material such as quartz glass or fluororesin that can pass the excitation light from the light source unit 2 and the fluorescent light emitted from the fluorescent material accumulated in the affected part OB of the patient PS and does not absorb the light. . The optical fiber 8 guides the excitation light from the light source unit 2 to the diseased part surface SF of the patient PS through the light emitting side opening at the distal end thereof, and emits the fluorescence emitted from the fluorescent substance in the tumor. It is guided to the detection unit 3 through the light receiving side opening at the tip.
[0039]
FIG. 2 shows an arrangement example of the light-emitting side opening and the light-receiving side opening in the optical fiber 8. In the example of FIG. 2, the optical fiber 8 has a light receiving side opening 8b at its center position in a sheath 8c thereof, and a plurality of light emitting side openings 8a... 8a having a radius of the light receiving side opening 8b. They are arranged at regular intervals at circumferential positions outside in the direction.
[0040]
As the detection unit 3, for example, a spectrometer that separates and measures the intensity of only a specific wavelength band among the wavelength components of the fluorescence emitted from the fluorescent substance accumulated in the affected area OB and converts the intensity into an electric signal is applied. . This spectrometer includes, for example, a detector in which a convex diffraction grating, a lens and a diffraction grating, an optical filter and the like, a photodiode, a CCD, and the like are combined. The electric signal corresponding to the detected value of the fluorescence intensity near the affected part OB detected by the detection unit 3 is sent to the arithmetic unit 4.
[0041]
The arithmetic unit 4 is composed of a processing device such as a personal computer (PC), for example, and converts an electric signal corresponding to the fluorescence intensity detected by the detection unit 3 into a digital signal. And the like, and cancels out the influence of disturbance light, and executes a predetermined calculation process for estimating and calculating only the fluorescence intensity component derived from the fluorescent substance.
[0042]
In this arithmetic processing, for example, a measurement value Lon corresponding to the light source intensity when the excitation light source 21 is turned on and measured at the first wavelength not affected by the fluorescent substance, and a first value corresponding to the fluorescence intensity detected at that time. And the measured value Loff measured at a second wavelength different from the first wavelength corresponding to the light source intensity when the excitation light source 21 is turned off, and the fluorescence intensity detected at that time. From the measured value loff measured at the corresponding second wavelength, P = (lon-loff) / (Lon-Loff) as a parameter P corresponding to the concentration of the fluorescent substance, or a monotonic increase or a monotonic decrease with this parameter P Is calculated. This numerical value may be subjected to statistical processing such as averaging to reduce the measurement error.
[0043]
The display device 5 is composed of, for example, a CRT, a liquid crystal device, or the like, and visually displays a calculation result by the calculation device 4 by a numeral, a graph, a pseudo color display, or the like.
[0044]
The dye application device 6 includes a nozzle 6a for applying a biological tissue dye to a predetermined position. The operator confirms the calculation result on the display device 5 and determines that the diseased part OB (tumor tissue) on the diseased part surface SF is normal. When the boundary position with the tissue is determined, the living tissue dye is applied from the opening of the nozzle 6a toward the boundary position on the diseased part surface SF, thereby performing marking (recording). Among the dyes for living tissue used herein, for example, those that ensure biosafety, stain the affected part surface SF, have a color that can be visually distinguished from blood or the like, and do not affect the emission of the fluorescent substance are used. desirable.
[0045]
The suction device 7 includes a nozzle 7a having an opening for sucking and removing a liquid existing on the affected part surface SF, and the nozzle 7a can remove a body fluid or the like existing near the affected part surface SF only when the operator needs it. It is removed and stored in the waste liquid tank 7b.
[0046]
The diseased part surface protection device 9 is made of, for example, sterilized, resilient, plastic having a substantially spherical shape, and has a distal end portion of an optical fiber 8 forming a handpiece 10, a nozzle 6a of a dye coating device 6, and a suction device. It is preferable that the nozzle 7a has a structure in which the nozzle 7a can be disposed at an appropriate position. The diseased part surface protection device 9 protects the diseased part surface SF from being damaged by the distal end portion of the optical fiber 8 and the two nozzles 6a and 7a.
[0047]
Here, the operation of the present embodiment will be described.
[0048]
First, at the time of surgical operation for resection of the affected part of the patient PS, a fluorescent dye (eg, 5-ALA) having tumor accumulation is administered to the patient PS, and the tip of the handpiece 10 is lightly pressed against the living tissue of the patient PS. In the state, in the state where the normal illumination lamp 100 and the surgical light 110 are turned on in each of the part clearly seen as a normal tissue and the part clearly seen as a tumor part, the boundary of the above-mentioned fluorescent substance accumulation tumor The measurement by the identification device is performed.
[0049]
At the time of performing this measurement, the excitation light from the light source unit 2 is intermittently applied to the living tissue of the patient PS via the optical fiber 8, and the fluorescence intensity from the living tissue is detected by the detection unit 3 via the optical fiber 8. It is detected, and the detection signal is output to the arithmetic unit 4.
[0050]
Thereby, the arithmetic unit 4 cancels out the influence of the disturbance light when the normal illumination lamp 100 and the operating light 110 are turned on, thereby estimating only the fluorescence intensity component derived from the fluorescent substance using a calculation formula or the like for obtaining the above parameters.・ Calculate and record the value. In addition, a threshold for determining whether or not the tissue is a tumor tissue is obtained from past clinical experience values.
[0051]
Thereby, even when there is illumination by the surgical light 110 or the normal illumination lamp 100, the exposure range of the excitation light such as near ultraviolet light can be limited through the tip of the optical fiber 8 in the handpiece 10, so that the excitation light is From the intensity change data of the fluorescence wavelength between the case of irradiation and the case of non-irradiation, it is possible to quantitatively estimate the concentration of accumulated fluorescent substance. From this data, the boundary part of the tumor can be identified in real time. If a dye for living tissue is applied, the boundary can be visualized.
[0052]
Therefore, the surgeon gently presses the distal end of the handpiece 10 against the living tissue of the patient PS, and performs the above-described measurement. The boundary position between the tumor tissue and the normal tissue is identified, and the boundary position on the diseased part surface SF thus identified is marked by the dye coating device 6. Thus, when the necessary area is completely marked, surgical resection is performed at this stage. When further surgery is performed, the same marking → resection cycle is repeated until a necessary and sufficient portion is removed.
[0053]
Therefore, according to the present embodiment, even when the surgical light or the normal illumination light is turned on, the tumor region where the fluorescent dye is accumulated is quantitatively identified, and the boundary information thereof is marked on the surface of the diseased part such as the brain surface. Recording) and proceed with brain surgery under the same lighting conditions. That is, even when the surgical light or the like is turned on, the boundary portion of the affected part (tumor) can be clearly drawn, and based on the boundary part, only the necessary minimum affected part can be more safely removed. In addition, although marking with a dye for living tissue is relatively low-tech in itself, it is directly dyed on the surface of living tissue, so even if deformation occurs due to excision, unlike conventional superimposed display, it follows the deformation and follows the deformation There is also the advantage of keeping the border displayed.
[0054]
Note that the optical fiber 8 of the above embodiment may be provided with a condensing microlens at the tip thereof for preventing dispersion of the excitation light and ensuring its straightness. Further, the light guide means of the present invention is not limited to the optical fiber 8, but a light guide means using a mirror such as a laser knife can be used.
[0055]
In addition, the handpiece 10 of the present embodiment can integrate the distal end of the optical fiber 8, the nozzle 6a of the dye coating device 6, the nozzle 7a of the suction device 7, and the affected part surface protection device 9, so that the operator can easily hold it by hand. Any type can be applied as long as it has a shape. A specific example of the handpiece 10 is shown in FIGS.
[0056]
The handpiece 10 shown in FIG. 3 has a pen-shaped (rod-shaped) cylindrical main body that is easy to grasp with the hand, the tip of the optical fiber 8, the nozzle 6a of the dye coating device 6, the nozzle 7a of the suction device 7, and the affected part surface protection device. 9, two hand switches S1 (for control of fluorescence measurement) and S2 (for dye application) are provided at appropriate positions on the outer surface of the main body.
[0057]
In the handpiece 100, the opening of the optical fiber 8 does not necessarily need to be in contact with the affected part, but if the distance between the opening and the affected part surface SF changes, the measurement is performed according to the distance. If the fluorescence intensity changes, the concentration of the fluorescent substance may be erroneously estimated.
[0058]
Therefore, as shown in FIG. 4, the distance relationship between the opening end surface 10a of the optical fiber 8 and the diseased part surface SF is kept constant (see D in the figure), and the diseased part surface SF is thinned. In order to prevent damage by the nozzle 8 and the nozzles 6a and 7a, the affected part surface protection device 9 made of a soft resin that can be sterilized and has biosafety secured is attached to the distal end of the handpiece 10. The shape of the diseased part surface protection device 9 is preferably a substantially spherical shape from the viewpoint of catching with a living tissue or the like.
[0059]
Here, the operation of the present modified example will be described. With the affected part surface protection device 9 pressed against the affected part surface SF, the hand switch S1 is pressed, and a parameter corresponding to the concentration of the fluorescent substance is measured. In this case, the hand switch S1 may be one that measures only while the switch is kept depressed, or one that starts measurement at the time of the first press and stops measurement at the second time.
[0060]
Here, as a comparison parameter, a parameter P1 of a portion that can be clearly regarded as a tumor and a parameter P2 of a portion that can be clearly regarded as normal are registered in the apparatus in advance, and a parameter P3 at a position of interest is measured. For example, P1 is converted to 100% and P2 is converted to 0%, and the percentage is displayed as 100 × (P3−P2) / (P1−P2), or a numerical value or a figure in a monotonically increasing or monotonically decreasing relationship therewith. .
[0061]
Then, based on the measured values, the surgeon determines the boundary between the tumor tissue and the normal tissue, pushes the hand switch S2 for dye application on the handpiece 10 to the position determined as the boundary, The dye is applied through the nozzle 6a. This procedure is repeated to make a marking around the tumor area.
[0062]
When the marking is completed, surgical resection is performed on the marked tumor region. When the excision progresses to some extent, the affected part is deformed and the excision including the marking is performed, so the marking operation is repeated at that time. As a result, it is possible to safely remove the portion that needs to be removed by limiting it to a necessary and sufficient region.
[0063]
It should be noted that the present invention is not limited to the exemplary embodiment described above as a representative, and those skilled in the art may use various modes based on the description in the claims without departing from the spirit of the invention. Can be modified and changed. These changes and modifications also fall within the scope of the present invention.
[0064]
【The invention's effect】
As described above, according to the present invention, when identifying a tumor boundary using a tumor-accumulating fluorescent substance, it is possible to quantitatively distinguish from a normal tissue and mark the boundary quantitatively under normal illumination. It becomes possible with the configuration. As a result, it is possible to safely perform tumor excision or the like without disturbing the surgical procedure and accurately identifying the tumor region.
[Brief description of the drawings]
FIG. 1 is a schematic block diagram showing the overall configuration of a device for identifying a boundary of a fluorescent substance-accumulating tumor according to an embodiment of the present invention.
FIG. 2 is a schematic cross-sectional view showing an example of arrangement of a light receiving side opening and a light emitting side opening of an optical fiber.
FIG. 3 is a diagram illustrating the structure of a handpiece according to a modification.
FIG. 4 is a view for explaining the function of an affected part surface protection device arranged on the tip side of the handpiece.
FIG. 5 is a schematic block diagram showing the overall configuration of a conventional brain tumor identification device.
[Explanation of symbols]
1 Device body
2 Light source
3 Detector
4 arithmetic unit
5 Display device
6 Dye coating device
6a nozzle (dye coating device)
7 Suction device
7a Nozzle (suction device)
7b Waste liquid tank
8 Optical fiber
9 Protective device
10 Handpiece
21 Excitation light source
22 Optical Filter
100 operating light
110 Normal lighting
PS patient
OB affected area
SF affected area surface

Claims (8)

A light source that irradiates excitation light of a predetermined wavelength component to a fluorescent substance that has been chemically modified by being accumulated in an affected part of a subject in a living body and intermittently excites the fluorescent substance by repeating lighting and extinguishing thereof,
Light guiding means for guiding the excitation light from the light source to the vicinity of the affected part in the living body,
Detecting means for detecting the intensity of the fluorescence emitted from the fluorescent substance accumulated in the affected part,
Calculation means for estimating the concentration of the fluorescent substance based on the fluorescence intensity corresponding to turning on and off the light source detected by the detection means,
Display means for displaying an estimated value of the concentration of the fluorescent substance by the calculating means. The light source may be a halogen lamp light source or a metal halide lamp light source having a mechanical shutter and an optical filter that transmits light having a component near a specific wavelength, or an LED (light emitting diode) having excellent responsiveness of turning on and off the light source. 2. The apparatus according to claim 1, wherein the LED is provided with an optical filter. The light guide unit includes an optical fiber that guides the excitation light to an affected area where the fluorescent substance accumulates, and guides fluorescence emitted from the fluorescent substance by the excitation light to the detection unit. Item 7. The apparatus for identifying a boundary of a fluorescent substance-accumulating tumor according to Item 1. The said detection means is comprised from the diffraction grating which combined the concave-shaped diffraction grating, the convex-shaped diffraction grating, or the lens, and the photodetector which converts light into an electrical signal. Identification device for fluorescent material-accumulating tumor. The calculation means sets a measurement value at a first wavelength corresponding to the intensity of the excitation light when the light source is turned on to Lon, and a measurement value at a first wavelength corresponding to the intensity of the excitation light when the light source is turned off. Is Loff, a measured value at a second wavelength different from the first wavelength corresponding to the intensity of the fluorescence detected by the detection means when the light source is turned on is lon, and the measurement value is detected by the detection means when the light source is turned off. Where the measured value at the second wavelength different from the first wavelength corresponding to the intensity of the fluorescent light is loff and the parameter corresponding to the concentration of the fluorescent substance is P, the parameter P = (lon-loff) / ( Lon-Loff) or that a numerical value having a monotonic increase or a monotonically decreasing relationship with the parameter P is calculated with respect to a change in the parameter P. Boundary identification apparatus of a fluorescent substance accumulation tumors according to claim 1, symptoms. A dye application unit having an opening for applying a dye to the affected part surface estimated by the calculation unit and performing marking,
A suction unit having an opening for suctioning and removing the liquid on the surface of the affected part, wherein the opening of the dye application unit and the opening of the suction unit are arranged at predetermined positions near the tip of the optical fiber. The apparatus for identifying a boundary of a fluorescent substance-accumulating tumor according to claim 3, characterized in that: 4. The apparatus according to claim 3, further comprising a protection means detachably attached to the tip of the optical fiber and having a gently curved shape. 4. The apparatus according to claim 3, wherein the distal end of the optical fiber is formed of a handpiece detector.

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