JP6128873B2 - Laser therapy device - Google Patents

Description

  The present invention relates to a laser therapy apparatus.

  Conventionally, there is known a laser treatment apparatus that treats a lesioned part by irradiating a lesioned part of a living body with laser light to thermally coagulate the tissue (see, for example, Patent Documents 1 and 2). The apparatus described in Patent Document 1 captures a thermal coagulation state of a region irradiated with laser light in real time using an optical coherence tomography (OCT) image. The apparatus described in Patent Document 2 includes a scanning endoscope and an electronic endoscope, specifies the position of a treatment region by an electronic endoscope image, and uses the scanning endoscope to identify the position of the treatment region. The laser beam is irradiated.

JP 2002-1113017 A JP 2011-45461 A

  However, in the case of the apparatus of Patent Document 1, since the therapeutic laser beam is irradiated only to one minute region, it is difficult to clearly observe the thermal coagulation state of the tissue even if an OCT image is used. As a result, there is a problem that it is difficult to appropriately adjust the irradiation amount of the therapeutic laser beam. In the case of the apparatus of Patent Document 2, even if the relative position between the probe and the lesioned part changes, the therapeutic laser beam is applied only to the treatment region by making the scanning range of the treatment laser light follow the change in the relative position. Although there is an advantage that irradiation can be performed, there is a problem that the diameter of the probe increases because the electronic endoscope and the scanning endoscope are provided in parallel.

  The present invention has been made in view of the above-described circumstances, and can perform laser treatment while observing the thermal coagulation state of a treatment region in real time and clearly, with a probe having a small diameter configuration. An object of the present invention is to provide a laser treatment apparatus capable of irradiating treatment laser light only to a treatment region.

In order to achieve the above object, the present invention provides the following means.
The present invention includes an elongated probe inserted into the raw body, an elongated guide member disposed along the longitudinal direction within the probe, is emitted along a treatment laser beam to the optical axis of the illumination laser light, wherein By oscillating the light source part which supplies treatment laser light and the illumination laser light to the base end part of the light guide member, and the biaxial direction intersecting the longitudinal direction of the light guide member A scanning mechanism for two-dimensionally scanning the illumination laser light and the treatment laser light emitted from the tip of the light guide member on the living body, and detecting a return light of the illumination laser light reflected on the living body. A scan image constructing unit that constructs a scan image of an observation target region that is a scan range of the illumination laser light, and a partial region of the scan image constructed by the scan image constructing unit is set as a treatment region and set Is A treatment region setting unit for transmitting position, and stores the relative position of the feature point of the treatment region and the inner scan image when the treatment area by the treatment area setting unit is set as the initial position, after which the A deviation amount between the relative position between the feature point in the scanned image constructed by the scanned image construction unit and the treatment area and the stored initial position is calculated, and the deviation amount is equal to or less than a predetermined threshold value. When the supply of the treatment laser light is permitted, and the deviation amount is larger than the predetermined threshold, the supply of the treatment laser light is permitted by the determination unit that does not permit the supply of the treatment laser light , and the determination unit. When permitted, based on the position received from the treatment region setting unit, the light guide unit guides the light from the light source unit so that the treatment laser beam is scanned only in the treatment region of the scanned image. A controller that prevents the treatment laser light from being supplied from the light source unit to the light guide member when the treatment laser light is supplied to the material and the determination unit does not permit the supply of the treatment laser light; Provided is a laser treatment apparatus that supplies or stops the treatment laser light according to the judgment result of the judgment unit.

  According to the present invention, with the probe inserted into the living body, the illumination laser light is supplied from the light source unit to the light guide member, and the illumination laser light irradiated from the tip of the probe toward the tissue in the living body is the scanning mechanism. As a result of the scanning, a scanned image of the site to be observed in the living body is constructed by the image construction unit. At this time, the control unit scans the treatment laser beam together with the illumination laser beam only in the treatment region set by the treatment region setting unit among the observation target parts, so that the user can change the state of the treatment region in the scanned image in real time. In addition, laser treatment can be performed while clearly observing.

  In this case, after the treatment region is set by the treatment region setting unit and irradiation of the treatment laser light to the treatment region is started, the treatment laser light is based on the position of the observation target site in the scanned image by the determination unit. If the position of the observation target part is inappropriate, the irradiation of the treatment laser beam is quickly stopped. Thereby, a treatment laser beam can be irradiated only to a treatment area. In addition, the probe can be configured to have a small diameter by performing imaging of a region to be observed and irradiation of treatment laser light using a single light guide member.

In the above invention, the determination unit stores, as an initial position, a relative position between the treatment region and the feature point in the scanned image when the treatment region is set by the treatment region setting unit. A deviation amount between the relative position between the feature point in the scanned image constructed by the scanned image construction unit and the treatment area and the stored initial position is calculated, and the deviation amount is equal to or less than a predetermined threshold value. when permits the supply of the treatment laser beam, when the shift amount is greater than the predetermined threshold does not allow the supply of the treatment laser beam. The relative position may be a relative position between a centroid position of the treatment region and a feature point in the scanned image.
In this way, it is possible to accurately detect the position shift of the observation target part with respect to the set treatment region, and to quickly stop the irradiation of the treatment laser light when the position shift has occurred. .

Moreover, in the said invention, you may provide the scanning image display part which superimposes and displays the said treatment area | region set by the said treatment area | region setting part on the said scanning image.
By doing in this way, the user can grasp | ascertain easily the positional relationship of an observation object site | part and a treatment area | region from the scanning image currently displayed on the scanning image display part.

Moreover, in the said invention, you may provide the treatment area | region cancellation | release means which cancels | releases the setting of the said treatment area | region by the said treatment area | region setting part.
By doing in this way, after setting a treatment area | region once, another treatment area | region can be set again.

Moreover, in the said invention, you may provide the treatment laser beam stop means to forcibly stop supply of the said treatment laser beam from the said light source part to the said light guide member.
By doing in this way, the user can stop irradiation of the treatment laser beam to the living body at an arbitrary timing.

Moreover, in the said invention, according to the area of the said treatment area | region set by the said treatment area | region setting part, the treatment laser beam intensity | strength which adjusts the intensity | strength of the said treatment laser beam supplied to the said light guide member from the said light source part Adjustment means may be provided.
By doing in this way, the user can adjust the irradiation amount of the treatment laser beam to the treatment region more easily.

Moreover, in the said invention, the said treatment area | region setting part may set the area | region which has an area more than a predetermined threshold value as the said treatment area | region.
By doing so, it becomes difficult to confirm the thermal coagulation state of the treatment region in the scanned image due to the narrowing of the treatment region, and it becomes difficult to appropriately adjust the irradiation amount of the treatment laser beam. Can be prevented.

In the above invention, the scanning mechanism may be a piezoelectric element that is fixed near the tip of the light guide member and can expand and contract in a longitudinal direction of the light guide member, and an alternating voltage is applied to the piezoelectric element to apply the piezoelectric element. And a drive part that expands and contracts in the longitudinal direction.
By doing in this way, illumination laser light and treatment laser light can be scanned with a simple configuration.

In the above invention, the low coherent light source that emits low coherent light and the low coherent light emitted from the low coherent light source are combined with the illumination laser light and the treatment laser light on the optical axis. A multiplexing unit, provided between the low coherent light source and the multiplexing unit, divides the low coherent light emitted from the low coherent light source into measurement light and reference light to divide the measurement light into the multiplexing light. And a tomographic image construction for constructing a tomographic image of the site to be observed from an interference signal obtained at the interference unit, and an interference unit for causing the measurement light returning from the site to be observed to interfere with the reference light A tomographic image display unit that displays the tomographic image constructed by the tomographic image construction unit.
By doing in this way, the thermal coagulation state in a position deeper than the surface of the treatment area can be observed in real time.

In the above invention, a tomographic image region setting unit that sets a partial region of the scanned image constructed by the scanned image constructing unit as a tomographic image region is provided, and the control unit The measurement light may be supplied to the multiplexing unit so that the low-coherent light is scanned only in the tomographic image region.
By doing in this way, any area | region among observation object site | parts can be set as a tomographic image area | region.

In the above invention, the tomographic image region setting unit may set a peripheral edge of the treatment region set by the treatment region setting unit as the tomographic image region.
By doing in this way, the area | region surrounding a treatment area | region can be set as a tomographic image area | region, without requiring operation by a user.

  According to the present invention, it is possible to perform laser treatment while observing the thermal coagulation state of the treatment region in real time and clearly, with the probe having a small diameter, and irradiating treatment laser light only to the treatment region. There is an effect that can be.

1 is an overall configuration diagram of a laser treatment apparatus according to a first embodiment of the present invention. It is the (a) longitudinal cross-sectional view of the front-end | tip part of the probe with which the laser treatment apparatus of FIG. (A), (b) It is an example of the endoscopic image displayed on the setting screen of an operation part, and (c) It is an example of the endoscopic image displayed on a monitor. It is a flowchart which shows operation | movement of the laser treatment apparatus of FIG. It is a figure explaining the timing at which treatment laser light is emitted. (A), (b) It is an example of the endoscopic image displayed on the setting screen of an operation part in the 1st modification of the laser treatment apparatus of FIG. It is a flowchart which shows the operation | movement of the 2nd modification of the laser treatment apparatus of FIG. It is a whole block diagram of the laser treatment apparatus which concerns on the 2nd Embodiment of this invention. It is a flowchart which shows operation | movement of the laser treatment apparatus of FIG. It is an example of (a) endoscopic image and (b) OCT image displayed on a monitor. It is a modification of the endoscopic image displayed on a monitor.

(First embodiment)
Hereinafter, a laser treatment apparatus 1 according to a first embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 1, the laser treatment apparatus 1 according to the present embodiment has an elongated probe 2 inserted into the body and a light source that supplies the illumination laser light L1 and the treatment laser light L2 to the probe 2 from the proximal end side. A scanning mechanism 4 that scans laser beam L1 and L2 emitted from the tip of the probe 3 and the probe 2 on the observation target site of the living body A, and the return light L1 ′ of the illumination laser beam L1 reflected from the observation target site. An endoscope image construction unit 5 for constructing an image, an operation unit (treatment region setting unit) 6 for setting a treatment region X irradiated with the treatment laser light L2, a control unit 7, and a monitor (scanned image display unit) 8 and.

  As shown in FIG. 2, the probe 2 includes an elongated cylindrical sheath 21 having flexibility, an illumination fiber (light guide member) 22 disposed in the sheath 21 along the longitudinal direction, and a light receiving fiber. 23 and a focusing optical system 24 disposed on the distal end side of the illumination fiber 22.

  The illumination fiber 22 guides the illumination laser light L1 and the treatment laser light L2 supplied from the light source unit 3 to the incident end on the proximal end side, and emits the light from the emission end 22a on the distal end side. The illumination laser beam L1 and the treatment laser beam L2 emitted from the emission end 22a are focused by the focusing optical system 24 and applied to the living body A.

  The light receiving fiber 23 receives the return light L1 ′ of the illumination laser light L1 from the observation target site of the living body A on the light receiving surface 23a formed of the distal end surface thereof, and guides it to the proximal end connected to the photodetector 51 described later. To do. A plurality of light receiving fibers 23 are provided, and a light receiving surface 23 a is arranged on the distal end surface of the probe 2 so as to surround the focusing optical system 24 in the circumferential direction.

  The light source unit 3 includes a first light source 31 that emits the illumination laser light L1, a second light source 32 that emits the treatment laser light L2, the illumination laser light L1 emitted from the two light sources 31 and 32, and the treatment. And an optical multiplexer 33 such as a dichroic optical coupler that combines the laser light L2 and emits the laser light L2 along a single optical axis. Reference numeral 34 denotes a light guide fiber that connects the optical elements 31, 32, and 33. The illumination laser beam L1 and the treatment laser beam L2 emitted from the optical multiplexer 33 are incident on the incident end of the illumination fiber 22 through the light guide fiber 34 and the optical connector 35.

The scanning mechanism 4 includes an actuator 41 that is provided at the tip of the illumination fiber 22 and vibrates the emitting end 22a of the illumination fiber 22 in a direction that intersects the longitudinal direction, and a drive unit 42 that drives the actuator 41.
The actuator 41 is a piezo type, and is a rectangular tube-shaped ferrule 41a fixed so as to surround the outer peripheral surface of the illumination fiber 22 in the circumferential direction, and four plate-shaped piezoelectric elements attached to four side surfaces of the ferrule 41a. And an element 41b. Reference numeral 41c is a fixing member that fixes the illumination fiber 22 to the sheath 21 at the proximal end of the ferrule 41a.

  When an alternating voltage is applied from the drive unit 42 to the piezoelectric element 41 b, the piezoelectric element 41 b expands and contracts in the longitudinal direction of the illumination fiber 22, and the ferrule 41 a elastically deforms according to the expansion and contraction of the piezoelectric element 41 b and emits from the illumination fiber 22. The end 22a is made to vibrate in a direction crossing the longitudinal direction. Further, the scanning mechanism 4 appropriately adjusts the phase and amplitude of the alternating voltage applied from the driving unit 42 to the four piezoelectric elements 41b, so that the emission end 22a of the illumination fiber 22 intersects the longitudinal direction thereof. In FIG. 5, the vibration is made along a spiral vibration locus. As a result, the illumination laser light L1 and the treatment laser light L2 emitted from the emission end 22a of the illumination fiber 22 are two-dimensionally scanned along the spiral trajectory in the observation target site of the living body A.

  The endoscope image construction unit 5 detects a return light L1 ′ guided through the light receiving fiber 23 and photoelectrically converts it, and converts an electrical signal output from the photodetector 51 into a digital signal. Stores the position of the treatment region X set by the operation unit 6 and the image generation circuit 53 that generates a two-dimensional endoscope image from the digital signal generated by the AD converter 52. And a memory 54.

  The image generation circuit 53 associates the digital signal received from the AD converter 52 with the scanning position of the illumination laser beam L1, thereby making the two-dimensional internal view of the observation target region as shown in FIG. A mirror image (scanned image) is generated. At this time, when the position of the treatment area X is stored in the memory 54, the image generation circuit 53 superimposes the treatment area X on the endoscope image G as shown in FIG. To do. Then, the endoscope processing circuit 53 outputs the generated endoscope image G to the monitor 8 and the operation unit 6 via the control unit 7.

  The operation unit 6 includes an operation panel operated by a user. The operation panel includes a start button and an end button (treatment laser light stop means) indicating start and stop of irradiation of the treatment laser light L2, respectively, a setting screen for setting the treatment region X irradiated with the treatment laser light L2, and once. A reset button (treatment area release means) indicating release of the set treatment area X.

When operated by the user, each button transmits a signal instructing to start or stop irradiation of the treatment laser light L2 or reset the treatment region X to the control unit 7.
An endoscope image G generated by the endoscope image construction unit 5 is displayed on the setting screen. As shown in FIG. 3B, when a partial area in the endoscopic image G is designated using an input device such as a mouse, the position of the designated area is an irradiation area. The position X is transmitted to the control unit 7 and is stored in the memory 54 of the endoscope image construction unit 5.

  The control unit 7 continuously operates the first light source 31 and the scanning mechanism 4 to continuously scan the illumination laser light L1 on the observation target portion of the living body A, and the endoscope image construction unit 5 An endoscopic image G is continuously generated. Further, when the control unit 7 receives the position of the treatment region X from the operation unit 6, the control unit 7 calculates a period corresponding to the treatment region X in the scanning cycle of the illumination laser light L1, and the second light source only during the calculated period. The treatment laser beam L2 is emitted from 32.

  Here, when the control unit (determination unit) 7 receives the position of the treatment region X from the operation unit 6, the control unit (determination unit) 7 stores the position of the treatment region X and stores the position of the treatment region X in the endoscopic image G. The relative position with respect to the observation target part is stored as the initial position. For example, the control unit 7 extracts a feature point from the observation target part in the endoscopic image G, and stores the relative position between the extracted feature point and the center of gravity of the treatment region X as an initial position. When the control unit 7 receives a new endoscopic image G from the image generation circuit 53, the control unit 7 calculates the relative position between the observation target region and the treatment region X in the endoscopic image G, and calculates the calculated relative Compare the position to the initial position.

  As a result of the comparison, when the amount of deviation of the calculated relative position from the initial position is equal to or less than a predetermined threshold value, the control unit 7 outputs the treatment laser light L2 from the second light source 32 at a timing corresponding to the treatment region X. Let it emit. On the other hand, when the amount of deviation of the calculated relative position from the initial position is larger than a predetermined threshold, the control unit 7 temporarily stops the emission of the treatment laser light L2 from the second light source 32.

Next, the operation of the laser treatment apparatus 1 configured as described above will be described with reference to FIG.
In order to treat the lesioned part B of the living body A using the laser treatment apparatus 1 according to the present embodiment, the user inserts the probe 2 into the body and monitors the endoscopic image G of the living body A by the illumination laser light L1. 8 (step S1), the probe 2 is arranged at a position where the lesioned part B is included in the endoscopic image G.

  Next, the user designates a region including the lesioned part B in the endoscopic image G as the treatment region X using the setting screen of the operation unit 6 (step S2). The designated position of the treatment region X is transmitted from the operation unit 6 to the control unit 7, and the treatment region X is superimposed on the endoscopic image G by the image generation circuit 53. As a result, the treatment region X is superimposed and displayed on the endoscopic image G on the monitor 8 (step S3).

  Next, the user operates the start button of the operation unit 6. Thereby, irradiation of the treatment laser beam L2 to the treatment region X is started (step S5). That is, as shown in FIG. 5, the treatment laser light L2 is emitted only during the period corresponding to the treatment region X (the period surrounded by the frame in the figure) in the scanning period T of the illumination laser light L1. FIG. 5 shows only the temporal change in the scanning amplitude in one of the two axial directions in which the illumination laser beam L1 is scanned.

  Here, in the endoscopic images G that are continuously generated, the relative position between the treatment region X and the site to be observed is confirmed by the control unit 7, and the distal end of the probe 2 is moved. If it deviates from B (YES in step S4), the irradiation of the treatment laser beam L2 is temporarily interrupted (step S6). Then, when the user adjusts the position of the tip of the probe 2 and the treatment region X returns to an appropriate position with respect to the lesioned part B (NO in step S4), the emission of the treatment laser light L2 is resumed ( Step S5).

  The user observes the state of the lesioned part B in the endoscopic image G on the monitor 8, confirms that the lesioned part B is sufficiently heat-coagulated, and operates the end button of the operation unit 6 (step S7). YES) Thereby, irradiation of the treatment laser beam L2 to the living body A is completed (step S8).

  Thus, according to the present embodiment, the current state of the tissue in the treatment region X irradiated with the treatment laser beam L2 is clearly observed in real time by the endoscopic images G acquired continuously. Therefore, there is an advantage that the user can easily and appropriately adjust the irradiation amount of the treatment laser beam L2 with respect to the treatment region X. When the relative position between the tip of the probe 2 and the observation target site is shifted after the user once sets the treatment region X and the amount of shift becomes larger than a predetermined threshold, the treatment laser beam L2 is irradiated onto the living body A. Is quickly stopped. Accordingly, there is an advantage that it is possible to prevent the treatment laser beam L2 from being irradiated to the region other than the treatment region X and to irradiate the treatment laser beam L2 only to the set treatment region. Furthermore, since the common illumination fiber 22 is used to irradiate the living body A with the illumination laser beam L1 and the treatment laser beam L2, there is an advantage that the probe 2 can be reduced in diameter.

Next, a modified example of the laser treatment apparatus 1 according to this embodiment will be described.
As a first modification of the present embodiment, instead of the operation unit 6 being designated by the user as an arbitrary region of the endoscopic image G as the therapeutic region X, a plurality of preset therapeutic regions One may be selected by the user. For example, as shown in FIG. 6 (a), circles with different radii centered on the center of the endoscopic image G are displayed on the setting screen as treatment regions X1, X2, and X3, and are shown in FIG. 6 (b). As shown, any one of the regions X2 may be selected and designated.
By doing in this way, since the control part 7 should just radiate | emit treatment laser light L2 in the period calculated beforehand among the scanning periods of illumination laser light L1, it simplifies the process of the control part 7. be able to.

  As a second modification of the present embodiment, whether or not the operation unit 6 calculates the area of the region designated as the treatment region X by the user and accepts the designation of the treatment region X based on the calculated area. May be judged.

  When the calculated area is equal to or greater than a predetermined threshold, the operation unit 6 receives the designation of the treatment region X and transmits the position of the treatment region X to the control unit 7. On the other hand, when the calculated area is smaller than the predetermined threshold, the operation unit 6 rejects designation of the treatment region X and displays a message on the setting screen or outputs an alarm sound, for example. Thus, the user is notified that the designation of the treatment area X has been rejected.

  According to the laser treatment apparatus 1 according to this modification configured as described above, as shown in FIG. 7, when the treatment region X is designated by the user in step S2, the area S of the treatment region X is calculated. (Step S101), the calculated area S is compared with a predetermined threshold Smin (Step S102). If the area S is equal to or greater than the threshold value Smin (YES in step S102), the process proceeds to step S3, where the treatment region X can be irradiated with the treatment laser light L2. On the other hand, when the area S is smaller than the threshold value Smin (NO in step S102), steps S3 to S8 are not executed, and the user is requested to respecify the treatment region X (step S103).

  In this way, when the treatment region X is excessively narrow, the treatment region X cannot be observed sufficiently clearly in the endoscopic image G. As a result, the irradiation amount of the treatment laser light L2 to the treatment region X is reduced. Proper adjustment can be difficult. Therefore, by ensuring a sufficiently large area of the treatment region X, the user can easily and appropriately adjust the irradiation amount of the treatment laser light L2 to the treatment region X.

Furthermore, in this modification, when the area S is equal to or greater than the threshold value Smin, the intensity of the treatment laser light L2 may be set according to the area S of the treatment region X (step S104). That is, the control unit (treatment laser light intensity adjusting means) 7 controls the output intensity of the second light source 32 so that the treatment laser light L2 becomes weaker as the area S of the treatment region X is smaller.
By doing in this way, the user can adjust the irradiation amount of the treatment laser beam L2 to the treatment region X more easily.

(Second Embodiment)
Next, a laser treatment apparatus 1 according to a second embodiment of the present invention will be described with reference to FIGS. In the present embodiment, the configuration different from the first embodiment will be mainly described, and the configuration common to the first embodiment will be denoted by the same reference numerals and the description thereof will be omitted.
As shown in FIG. 8, the laser treatment apparatus 1 according to the present embodiment further includes an optical system for acquiring an optical coherence tomography (OCT) image of the observation target portion of the living body A. This is mainly different from the first embodiment.

  Specifically, a third light source (low coherent light source) 9 that emits near-infrared low-coherence light L3, a fourth light source 10 that emits aiming light L4, and low-coherence from the third light source 9 An interferometer such as an optical coupler that splits the light L3 into the measurement light L31 and the reference light L32 and emits the measurement light L31 returned from the observation target portion of the living body A and interferes with the reference light L32. Interference unit 11, frequency shifter 12 that modulates the reference light L 32 emitted from the interferometer 11, optical path length adjustment unit 13 that adjusts the optical path length of the reference light L 32, and measurement combined by the interferometer 11 An OCT image construction unit (tomographic image construction unit) 14 that generates an OCT image from the interference light L3 ′ between the light L31 and the reference light L32 is provided.

The third light source 9 emits low coherence light L3 having a sufficiently short coherence length.
The fourth light source 10 emits laser light in the visible range as aiming light L4.

  Reference numeral 15 denotes an optical fiber that guides the laser beams L3, L31, L32, and L4 by connecting the optical elements 9, 10, 11, 12, and 33 to each other. These optical fibers 15 are preferably single mode fibers or low-order multimode fibers that can sufficiently maintain coherence, and may be polarization maintaining fibers or the like.

  Of the low-coherence light L3 emitted from the third light source 9, the measurement light L31 divided by the interferometer 11 and the aiming light L4 emitted from the fourth light source 10 are supplied to the optical multiplexer (multiplexing unit) 33. Incident light is combined with the illumination laser beam L1 and the treatment laser beam L2 by the optical multiplexer 33, and is supplied to the illumination fiber 22 together with these laser beams L1 and L2. The measurement light L31 reflected by the living body A is again guided through the illumination fiber 22 from the exit end 22a to the entrance end, and returns to the interferometer 11 via the optical multiplexer 33.

  The frequency shifter 12 changes the frequency of the reference light L32 emitted from the interferometer 11 and emits it to the optical path length adjustment unit 13. As the frequency shifter 12, for example, an acousto-optic element, an electro-optic element, or a piezo element provided with a fiber loop is used.

  The optical path length adjustment unit 13 includes a collimator lens 131 that converts the reference light L32 emitted from the frequency shifter 12 into parallel light, a movable mirror 132 that folds back the parallel light from the collimator lens 131 to the collimator lens 131, and the movable And a motor 133 that moves the mirror 132 in the optical axis direction of the collimator lens 131. By adjusting the position of the movable mirror 132 in the optical axis direction of the collimator lens 131 by the motor 133, the optical path length of the reference light L32 is adjusted.

  Here, in the interferometer 11, the optical path length of the measurement light L31 returned from the observation target site of the living body A and the optical path length of the reference light L32 returned from the optical path length adjustment unit 13 are coherence of the low coherence light L3. When they coincide in the long range, the interferometer 11 emits interference light L3 ′ having a frequency variation equal to or twice the frequency transition amount by the frequency shifter 12. That is, by setting the position of the movable mirror 132 of the optical path length adjustment unit 13 so that the optical path length of the reference light L32 coincides with the optical path length of the measurement light L31, information from the observation target site of the living body A can be obtained. Obtained as interference light L3 ′.

  The OCT image construction unit 14 detects the interference light L3 ′ emitted from the interferometer 11, and demodulates the signal having a predetermined frequency from the interference light L3 ′ detected by the light detector 141. , An AD converter 143, an image generation circuit 144, and a memory 145.

The photodetector 141 converts the detected interference light L3 ′ into an electrical signal and outputs the electrical signal to the demodulator 142.
The demodulator 142 extracts the signal in the vicinity of the frequency that is equal to, twice, or higher than the frequency transition amount of the frequency shifter 12 from the electrical signal input from the photodetector 141, thereby observing the living body A. A signal from the target site can be detected with a high S / N ratio by optical heterodyne detection.
The image generation circuit 144 generates an OCT image by associating the digital signal received from the AD converter 143 with the scanning position of the measurement light L31, and monitors the generated OCT image via the control unit 7 (tomographic image display unit). 8 and the operation unit 6.

  In the present embodiment, the operation panel of the operation unit (tomographic image region setting unit) 6 has another setting screen for setting an OCT image region Y for acquiring an OCT image. When a partial area in the endoscopic image G displayed on another setting screen is designated by the user, the position of the designated area is controlled as the position of the OCT image area (tomographic image area) Y. It is transmitted to the unit 7.

  When receiving the position of the OCT image region Y from the operation unit 6, the control unit 7 calculates a period corresponding to the OCT image region Y in the scanning cycle of the illumination laser light L1 as in the case of the treatment region X. During this period, the low-coherence light L3 and the aiming light L4 are emitted from the light sources 3 and 4, respectively.

Next, the operation of the laser treatment apparatus 1 configured as described above will be described with reference to FIG.
In order to treat the lesioned part B of the living body A using the laser treatment apparatus 1 according to the present embodiment, steps S1 to S2 are performed in the same manner as in the first embodiment. After step S2, the user designates the OCT image region Y using another setting screen of the operation unit 6 (step S201). The designated position of the OCT image region Y is transmitted from the operation unit 6 to the control unit 7, and as shown in FIG. 10A, the treatment region X and the OCT image region Y are added to the endoscopic image G on the monitor 8. Are superimposed and displayed (step S202).

  Next, the user operates the start button of the operation unit 6. Thereby, the irradiation of the low coherence light L3 to the OCT image region Y and the acquisition of the OCT image start (step S203), and the irradiation of the treatment laser beam L2 to the treatment region X starts (step S5). That is, in the scanning period T of the illumination laser light L1, the treatment laser light L2 is emitted only during the period corresponding to the treatment region X, and the measurement light L31 and the aiming light L4 are emitted only during the period corresponding to the OCT image acquisition region Y. (Step S6).

In the present embodiment, the aiming light L4 irradiated to the observation target region is photographed in the endoscopic image G together with the illumination laser light L1, so that an OCT image is photographed in the endoscopic image G displayed on the monitor 8. The range can be confirmed.
FIG. 10B shows an example of the OCT image G ′ displayed on the monitor 8. In the same figure, the code | symbol C has shown the part heat-coagulated.

  The user observes the state of the lesioned part B in the endoscopic image G and the OCT image G ′ on the monitor 8, confirms that the lesioned part B is sufficiently heat-coagulated, and operates the end button of the operation unit 6. (YES in step 7). Thereby, irradiation of the treatment laser beam L2 and the low coherence beam L3 to the living body A is completed (step S204).

  As described above, according to the present embodiment, in addition to the effect of the first embodiment, the thermal coagulation state at a position deeper than the tissue surface of the treatment region X irradiated with the treatment laser light L2 is expressed by the OCT image. Since it can confirm in real time, there exists an advantage that the irradiation amount of the treatment laser beam L2 can be adjusted further appropriately.

Next, a modified example of the laser treatment apparatus 1 according to this embodiment will be described.
As a modification of the present embodiment, the operation unit 6 is replaced with a control unit 7 as shown in FIG. 11 instead of the user specifying an arbitrary region of the endoscopic image G as the OCT image region Y. However, the outer edge of the treatment area X may be set as the OCT image area Y.
By doing in this way, a user's effort can be saved.
In the present embodiment, the first and second modifications of the first embodiment may be applied as appropriate.

DESCRIPTION OF SYMBOLS 1 Laser treatment apparatus 2 Probe 22 Illumination fiber (light guide member)
3 Light source unit 33 Optical multiplexer (multiplexing unit)
4 Scanning Mechanism 41b Piezoelectric Element 42 Drive Unit 5 Endoscope Image Building Unit (Scanning Image Building Unit)
6 Operation unit (treatment region setting unit, tomographic image region setting unit, treatment region release means)
7 Control unit (determination unit, treatment laser beam stop unit, treatment laser beam intensity adjustment unit)
8 Monitor (scanned image display section, tomographic image display section)
9 Third light source (low coherent light source)
11 Interferometer (interference part)
14 OCT image construction unit (tomographic image construction unit)
X treatment area Y OCT image area

Claims (11)

An elongated probe inserted into the living body;
An elongated light guide member disposed along the longitudinal direction in the probe;
A light source unit that emits treatment laser light along an optical axis of illumination laser light, and supplies the treatment laser light and the illumination laser light to a base end portion of the light guide member;
The illumination laser beam and the treatment laser beam emitted from the tip of the light guide member are vibrated on the living body by vibrating the tip portion of the light guide member in a biaxial direction intersecting the longitudinal direction of the light guide member. A scanning mechanism for two-dimensional scanning;
A scanning image construction unit that detects return light of the illumination laser light reflected on the living body and constructs a scanning image of an observation target site that is a scanning range of the illumination laser light;
A treatment region setting unit configured to set a partial region of the scan image constructed by the scan image construction unit as a treatment region and transmit the set position;
Relative position between the treatment area and the feature point in the scan image when the treatment area is set by the treatment area setting unit is stored as an initial position, and then the scan constructed by the scan image construction unit A deviation amount between the relative position between the feature point in the image and the treatment area and the stored initial position is calculated, and when the deviation amount is equal to or less than a predetermined threshold, the treatment laser light is supplied. Permitting, when the amount of deviation is larger than the predetermined threshold , a determination unit that does not permit the supply of the treatment laser light ; and
When supply of the treatment laser beam is permitted by the determination unit, the treatment laser beam is scanned only in the treatment region of the scanned image based on the position received from the treatment region setting unit. The treatment laser light is supplied from the light source unit to the light guide member, and the treatment laser light is supplied from the light source unit to the light guide member when the determination unit does not permit the supply of the treatment laser light. And a control unit that does not let
A laser treatment apparatus that supplies or stops the treatment laser beam according to a judgment result of the judgment unit. The determination unit stores, as an initial position, a relative position between the center of gravity of the treatment region and the feature point in the scan image when the treatment region is set by the treatment region setting unit. The laser treatment apparatus according to claim 1 , wherein a deviation amount between the relative position between the feature point in the scanned image constructed by the construction unit and the gravity center position of the treatment region and the stored initial position is calculated. Laser treatment apparatus according to claim 1 or claim 2 comprising a scanning image display unit for displaying by superimposing the treatment area set by said treatment area setting unit to the scanned image. The laser treatment apparatus according to any one of claims 1 to 3 , further comprising a treatment region canceling unit that cancels the setting of the treatment region by the treatment region setting unit. The laser treatment apparatus according to any one of claims 1 to 4 , further comprising a treatment laser light stopping unit that forcibly stops the supply of the treatment laser light from the light source unit to the light guide member. The treatment laser light intensity adjusting means for adjusting the intensity of the treatment laser light supplied from the light source unit to the light guide member according to the area of the treatment region set by the treatment region setting unit. The laser treatment apparatus according to claim 5 . The laser treatment apparatus according to any one of claims 1 to 6 , wherein the treatment region setting unit sets a region having an area equal to or larger than a predetermined threshold as the treatment region. The scanning mechanism is fixed in the vicinity of the front end of the light guide member and can expand and contract in the longitudinal direction of the light guide member, and an alternating voltage is applied to the piezoelectric element to expand and contract the piezoelectric element in the longitudinal direction. The laser treatment apparatus according to any one of claims 1 to 7, further comprising a drive unit. A low coherent light source that emits low coherent light; and
A combining unit that combines the low-coherent light emitted from the low-coherent light source with the illumination laser light and the treatment laser light on the optical axis;
Provided between the low coherent light source and the multiplexing unit, divides the low coherent light emitted from the low coherent light source into measurement light and reference light, and emits the measurement light to the multiplexing unit. An interference unit that causes the measurement light returning from the observation target site to interfere with the reference light;
A tomographic image construction unit for constructing a tomographic image of the observation target site from an interference signal obtained in the interference unit;
The laser treatment apparatus according to any one of claims 1 to 8 , further comprising a tomographic image display unit that displays the tomographic image constructed by the tomographic image construction unit. A tomographic image region setting unit that sets a partial region of the scanned image constructed by the scanned image construction unit as a tomographic image region;
The laser treatment apparatus according to claim 9 , wherein the control unit supplies the measurement light to the multiplexing unit so that the low-coherent light is scanned only in the tomographic image region in the observation target region. The laser treatment apparatus according to claim 10 , wherein the tomographic image region setting unit sets a peripheral edge of the treatment region set by the treatment region setting unit as the tomographic image region.

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