CN1193805C - 选择性光热解治疗设备 - Google Patents

选择性光热解治疗设备 Download PDF

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CN1193805C
CN1193805C CNB988140012A CN98814001A CN1193805C CN 1193805 C CN1193805 C CN 1193805C CN B988140012 A CNB988140012 A CN B988140012A CN 98814001 A CN98814001 A CN 98814001A CN 1193805 C CN1193805 C CN 1193805C
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electromagnetic radiation
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skin
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齐奥恩·阿扎尔
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DELIGHT TECHNOLOGIES Ltd
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/203—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser applying laser energy to the outside of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00137—Details of operation mode
    • A61B2017/00154—Details of operation mode pulsed
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A61B2018/00458—Deeper parts of the skin, e.g. treatment of vascular disorders or port wine stains
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B2018/1807—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using light other than laser radiation

Abstract

一种对被周围组织包围的外科手术目标进行选择性光热解治疗的方法和设备。该目标和周围组织被加热到60℃左右。然后，目标优选被单色光加热到凝固点。凝固目标与周围组织的温差足够微小使从目标向外扩散的热不会损伤周围组织，甚至在目标相当大的情况下，如曲张静脉，也不会损伤周围组织。

Description

选择性光热解治疗设备
所属领域与背景技术
本发明与皮肤外科手术有关，具体说，与选择性光热解治疗法有关，该法用于在不损伤周围健康组织的情况下，消除太大以至于不能用目前已知方法消除的目标，如曲张静脉。
选择性光热解治疗法是于1983年由Anderson和Parrish提出的一种外科手术方法(“选择性光热解治疗法：通过对脉冲辐射的选择性吸收进行准确显微外科手术”，科学，220卷，524-527页)，用以在对周围健康组织最小程度损伤的情况下，去除皮肤上或其附近的某些病变的或难看的组织。被去除的组织必须具备的特点在于，其在某一电磁辐射波长下对光的吸收与周围组织相比显著的强。该方法包括用优先被目标吸收的脉冲电磁辐射对目标和周围组织进行辐射，电磁辐射通常为可见光辐射。脉冲的能量和持续时间应使目标被加热到70℃左右到80℃左右之间，在这一温度下目标的蛋白质凝固。由于目标对于入射辐射的吸收强于周围组织，周围组织只是极轻微地加热。通常，辐射源为激光器，例如闪光灯脉冲染料激光器。激光源的优点在于其固有的单色性。其它的光源包括与窄带过滤器结合使用的宽带光源，例如在WO 91/15264中Gustaffson介绍的那样。一种类似的装置，被称作“Photoderm-VL”，由ESC医疗系统制造。
对于选择性光热解治疗法而言，适宜的目标包括：胎记、葡萄酒色痣、蛛网状静脉以及曲张静脉，由于含有比周围组织更高的含氧合血红蛋白的红血球，因此所有这些目标比周围组织更红。Anderson和Parrish使用的光的波长为577纳米，对应于577纳米的氧合血红蛋白的吸收带。随后585纳米被确定为是更有效的波长(Tian，Morrison和Kurban“585纳米用于处理葡萄酒色痣”，整形和修补性外科手术，86卷，第6期，1112-1117页)。
对于脉冲持续时间的限制是周围组织不许被加热到其也开始凝固的温度。当目标被加热时，热开始从目标向较冷的周围组织扩散。为使周围组织不被加热到受损伤的温度，脉冲长度必须被保持在目标的热松弛时间数量级上。对于较小的目标，例如胎记、葡萄酒色痣、蛛网状静脉，典型的脉冲长度在百微秒数量级上，对于曲张静脉，应采用的脉冲长度在毫秒数量级上。
在使用选择性光热解治疗法处理曲张静脉时产生一复杂情况。曲张静脉周围的正常组织一般包括其它血管，主要是毛细血管，也吸收入射辐射，但由于比曲张静脉小得多，因此具有短得多的热松弛时间。因此，从这些其它血管向周围组织扩散的热容易将周围组织加热到受损伤的温度，从而产生伤疤。
发明不损伤周围组织而有效去除较大外科手术目标，例如曲张静脉，的选择性光热解治疗法，其需求被广泛认可，并具有显著的优点。
发明综述
根据本发明，其提供了一种对被周围组织包围的目标进行选择性光热解治疗的方法，该方法包括如下步骤：(a)将目标和周围组织加热到正常体温以上；(b)将目标加热到70℃左右到80℃左右之间。
根据本发明，其提供了一种用于对被周围组织包围的目标进行选择性光热解治疗的设备，该设备包括：(a)用以产生宽带电磁辐射的装置；(b)用以产生至少一个基本上为单色电磁辐射脉冲的装置，所述至少一个基本上为单色电磁辐射脉冲之中的每一个脉冲与所述宽带电磁辐射基本上同步。
本发明的方法是基于这样一个事实，即从较热物体到较冷物体的热扩散速率与物体间的热梯度成比例。因此，将周围组织加热到高于正常体温的某一温度，但又不足以产生损伤，只有在此刻再将目标加热到凝固点，于是产生了这样一种环境，在这种环境下，一方面目标与周围血管间的热梯度，另一方面目标与其它周围组织间的热梯度，均足够小不至于使周围组织产生损伤。在本发明的上下文中，“正常体温以上”是指至少为40℃左右的一温度，但优选在55℃左右到65℃左右之间的某一温度。而且，用于加热目标的单色光脉冲可以比以往方法中的单色光脉冲具有更低的能量及更短的持续时间，因为所述目标从更高的初始温度加热。
本发明的装置通过使用宽带电磁辐射加热周围组织来达到这一目的。本发明的电磁辐射的波长范围包括所有有效的电磁辐射波长，而且用于这一用途的有效光谱包括微波辐射；但优选的用于加热周围组织和目标的光谱为可见光辐射。用以产生宽带光(白光)的优选装置为高强度光源灯，如氙弧灯。该装置包括一使从光源灯发出的光产生脉冲的机构。该机构可以包括用以控制输入光源灯的电流的回路(例如，该机构可以通过开和关光源灯进行运转)；或可以包括机械快门。
有两种用以产生用于加热目标的基本上为单色辐射的方法。第一种为激光器，其在所需波长下运转，优选位于570纳米左右到610纳米左右间的波长。第二种为将源自高强度光源灯的光通过一适当的波长选择装置，例如一窄带过滤器或一单色仪。
本发明的装置使单色光脉冲与宽带电磁辐射同步，采用的是众所周知的方法，以确保在单色光脉冲被打开而进一步加热目标前，周围组织已充分被加热，同时以确保在周围组织有机会冷却前目标被进一步加热。总之，这意味着如果宽带电磁辐射进行脉冲，那么每一个单色光脉冲与一个宽带脉冲基本上同步。其中，“基本上同步”意思是单色光脉冲要么在宽带脉冲打开时被打开，或者在宽带脉冲被关闭后立即被打开。
附图的简要说明
在这里参照附图，通过举例说明本发明。
其中，图1为本发明装置的优选实施例的简图，其中单色光的光源为激光器；
图2为图1装置的脉冲时间表；
图3为本发明装置的优选实施例的简图，其中单色光的光源与宽带光的光源相同；
图4为图3装置的脉冲时间表；
图5为图4装置的一替代实施例；
图6为图5装置的脉冲时间表。
优选实施例的说明
本发明涉及一种对于相当大的外科手术目标进行选择性光热解治疗的方法和设备。具体说，本发明可以用于去除曲张静脉和相似的发生病变的或难看的组织，同时对于周围健康组织只有最小程度的损伤。
本发明的选择性光热解治疗法的原理及其装置的操作可以参照附图及下述说明予以更好地理解。
现在来看附图，图1为本发明装置的优选实施例的简图。高强度光源灯10的作用在于其为宽带光(白光)14的光源。由于灯10发出的光各个方向都有，抛物线状反射器12和凹透镜16被提供用以使宽带光14平行，于是由光源灯10发出的所有能量基本上均被传送到目标和周围组织上。激光20也朝向目标和周围组织发出基本上的单色光24，优选585纳米的波长。控制系统30向光源灯10和激光20提供能量，同时按照图2所示关开光源灯10和激光20。
优选地，光源灯10为氙弧灯。优选地，激光20为闪光灯脉冲染料激光器，例如由Candela Corporati on of Wayland MA制造的ScleroLASER。
图2为图1装置的脉冲时间表。图2中实线代表宽带光14的脉冲持续时间和强度。图2中虚线代表单色光24脉冲的持续时间和强度。宽带光14在T0时刻被打开，然后保持足够长的时间直至T2时刻，从而使目标和周围组织被加热到60℃左右。当周围组织的温度接近所需终值时，单色光24在T1时刻被打开，然后保持至T3时刻，保持的时间足够长以使目标凝固，但不能过于长从而使周围组织受到损伤。优选地，单色光脉冲的持续时间在0.1毫秒左右到10毫秒左右之间。
图3为本发明装置的另一优选实施例的简图。在该实施例中，光源灯10所起的作用在于，对于目标和周围组织而言，其既为宽带辐射的光源，又为与其相关联的单色辐射的光源。在该实施例中，机械快门32用以使宽带光14交替地通过或被阻塞，从而使从该设备中发出的光产生脉冲。一旋转的圆形过滤器具有两部分，白色部分36和彩色部分38，用以过滤通过快门32的宽带脉冲。白色部分36将所有波长的强度均减弱到基本上相同的程度，因此提供具有适当强度和持续时间的宽带脉冲将目标和周围组织加热到60℃左右。彩色部分38将除以585纳米波长为中心的窄带光以外的光强度减弱。控制系统30使快门32和过滤器34运动同步以按照图4的脉冲时间表提供光脉冲的。
注意到，光源灯10在图3的实施例中要比在图1的实施例中具有更高的能量。原因在于，在图3的实施例中，光源灯10必须提供足够的位于585纳米附近的光能量来使目标凝固。正是由于该原因的存在，在该实施例中才要求过滤器34具有白色部分36。
图4为图3设备的脉冲时间表。与图2相同，实线代表宽带脉冲，虚线代表单色光脉冲。在T0时刻，随着过滤器34位置的变动，使白色部分36成为宽带光14的通路，快门32打开让宽带光14通过白光部分36，且光强被减弱。在T1时刻，过滤器34转动，彩色部分38插入宽带光14的光路。在T2时刻，所有的宽带光均通过彩色部分38，以至于从该设备中发出的光基本上为单色光。在T3时刻，快门32被关闭，单色光脉冲被终止。
图5为图3替代设备的简图。在图5的设备中，可移动镜40用来将通过快门32的光反射到固定镜41和单色仪42。图5的设备按图6所示的脉冲时间表产生脉冲，其中，实线仍代表宽带脉冲，虚线代表单色光脉冲。在T0时刻，随着动镜40撤出，快门32打开，使宽带光14通过用来减弱强度的过滤器44，从而到达目标和周围组织。与过滤器34的白色部分36相象，用来减弱强度的过滤器44将所有波长的光的强度均减弱到基本上相同的程度，以提供具有适宜持续时间和强度的宽带脉冲来将目标和周围组织加热到60℃左右。在T1时刻，可移动镜40回到原位，使宽带脉冲终止，同时反射宽带光14使其通过固定镜41，单色仪42，从而产生单色光脉冲。于是，单色光脉冲在宽带脉冲终止后立即产生。通过单色仪42的光只是以波长585纳米为中心的较窄的光谱的光。在T2时刻，快门32关闭，使单色光脉冲终止。
尽管本发明尽针对有限的实施例进行了说明，但应理解的是，该发明可进行众多的变动，修改和应用。

Claims (11)

1、一种用于对皮肤目标组织进行选择性光热解治疗的设备，其包括：
一可脉冲热源，其用于加热皮肤目标组织和该目标组织周围的皮肤；
一可脉冲的窄带电磁辐射源，其用窄带电磁波辐射皮肤而相比于所述目标组织周围的皮肤以选择性加热所述皮肤目标组织；和
一个控制器装置，其控制所述热源且所述窄带电磁辐射源，以调节所述热源和所述电磁辐射源的激活顺序；
其中，所述可脉冲热源适用于将皮肤目标组织和该目标组织周围的皮肤加热至低于所述皮肤目标组织凝固的温度，且相比于保持在低于所述皮肤目标组织凝固的温度的所述周围组织，所述窄带电磁波辐射的可脉冲源适用于将所述目标组织选择性加热至高于所述皮肤目标组织凝固的温度。
2、根据权利要求1所述的设备，其中所述可脉冲热源包括光源灯。
3、根据权利要求1所述的设备，其中所述热源包括用于加热皮肤的宽带电磁辐射源。
4、根据权利要求3所述的设备，其中所述宽带电磁辐射源包括光源灯。
5、根据权利要求3所述的设备，其中所述宽带电磁辐射源包括微波源。
6、根据前述权利要求任一所述的设备，其中所述的窄带电磁辐射的可脉冲源包括基本上为单色、脉冲式的电磁辐射源。
7、根据权利要求6所述的设备，其中所述的窄带电磁辐射具有570和610纳米之间的波长。
8、根据权利要求6所述的设备，其中所述的窄带电磁辐射的可脉冲源包括：
一光源灯；
一用于波长选择的机构。
9、根据权利要求8所述的设备，其中所述波长选择机构包括至少一个滤波器。
10、根据权利要求8所述的设备，其中所述波长选择机构包括至少一个单色仪。
11、根据权利要求6所述的设备，其中所述的窄带电磁辐射源包括激光器。
CNB988140012A 1996-09-04 1998-04-30 选择性光热解治疗设备 Expired - Fee Related CN1193805C (zh)

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IL139336A (en) 2008-11-03
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EP1079895A4 (en) 2005-06-22
AU7169598A (en) 1999-11-23
EA200001132A1 (ru) 2001-04-23
CN1299295A (zh) 2001-06-13
WO1999056824A1 (en) 1999-11-11
US5759200A (en) 1998-06-02
EP1079895A1 (en) 2001-03-07
IL139336A0 (en) 2001-11-25
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