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WO2013031637A1 - Système de navigation pour la respiration - Google Patents

Système de navigation pour la respiration Download PDF

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Publication number
WO2013031637A1
WO2013031637A1 PCT/JP2012/071315 JP2012071315W WO2013031637A1 WO 2013031637 A1 WO2013031637 A1 WO 2013031637A1 JP 2012071315 W JP2012071315 W JP 2012071315W WO 2013031637 A1 WO2013031637 A1 WO 2013031637A1
Authority
WO
WIPO (PCT)
Prior art keywords
lumen
medical
elongated body
navigation system
information
Prior art date
Application number
PCT/JP2012/071315
Other languages
English (en)
Japanese (ja)
Inventor
淳彦 野川
裕一 多田
有浦　茂樹
Original Assignee
テルモ株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by テルモ株式会社 filed Critical テルモ株式会社
Publication of WO2013031637A1 publication Critical patent/WO2013031637A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
    • A61B1/2676—Bronchoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00158—Holding or positioning arrangements using magnetic field
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2048—Tracking techniques using an accelerometer or inertia sensor

Definitions

  • the present invention relates to a navigation system for a respiratory region for guiding a medical device to a terminal in a respiratory region such as a bronchus.
  • COPD Chronic obstructive pulmonary disease
  • COPD refers to a broad group of pulmonary diseases that impede normal breathing, where the lungs are obstructed by the presence of at least one disease selected from asthma, emphysema and chronic bronchitis It is. COPD is often accompanied by these symptoms, and it is difficult to determine which disease is causing the lung obstruction in individual cases. Clinically, COPD is diagnosed by a decrease in exhaled flow from the lung, which is constant over several months and persists for more than 2 consecutive years in cases of chronic bronchitis. The two most serious conditions associated with COPD are chronic bronchitis and emphysema.
  • pulmonary emphysema refers to a state in which abnormal enlargement accompanied by destruction has occurred in tissues called alveolar parenchyma including respiratory bronchioles, alveolar passages, alveoli, and alveolar sac that serve as a place for gas exchange.
  • alveolar parenchyma contracts on expiration, but emphysematous alveolar parenchyma does not return after dilatation by respiration. For this reason, expiration cannot be performed sufficiently.
  • the effective area of the alveoli and the vascular bed are reduced, the ventilation capacity of the entire lung is reduced.
  • lung volume reduction surgery that removes lung lesions and promotes normal lung expansion (Lung volume reduction surgery) (LVRS) (see Non-Patent Document 1, for example), but lung volume reduction surgery removes not only the lesion area but also many normal areas near the lesion area. large.
  • a minimally invasive procedure is desirable in which a medical device is guided through the trachea to the lesion and only the lesion is treated or operated.
  • a medical device is guided through the trachea to the lesion and only the lesion is treated or operated.
  • the lumen from the trachea to the alveolar parenchyma is complicatedly branched, At present, it is difficult to accurately guide the medical device to a lesion located at the end of the lumen, and thus it is difficult to realize such a treatment.
  • the present invention has been made in view of such circumstances, and in order to realize a minimally invasive procedure such as emphysema treatment and biopsy, a respiratory region capable of accurately guiding a medical device to the distal side of a lumen
  • a minimally invasive procedure such as emphysema treatment and biopsy
  • a respiratory region capable of accurately guiding a medical device to the distal side of a lumen
  • a navigation system for a respiratory region has flexibility, a medical elongated body inserted into a branching lumen from the trachea, and the medical elongated body.
  • An information processing unit that connects, acquires information about the passage of the medical elongated body in the lumen, and stores information acquired in advance about the structure of the lumen including at least the passage;
  • medical information is obtained by referring to information on the path of passage of the medical elongated body and information acquired in advance about the structure of the lumen. Since it is possible to predict whether or not the passage route of the long body is a route that reaches the target site of the lumen, various treatment tools can be accurately guided along the medical long body, and thus the medical long body.
  • a length between a part of the portion of the medical elongated body inserted into the lumen and a reference position in the passage route of the medical elongated body is acquired. If the length information acquisition unit includes a length information acquisition unit including the length of the lumen along the lumen from the reference position, the length information acquisition unit obtains the length information acquisition unit. By comparing the length obtained and the length of the lumen acquired in advance, it is easy to predict the position where the medical long body has reached in the lumen. Various treatment tools can be guided accurately along the line.
  • the medical elongated body provided at the distal end of the medical elongated body, and having a guide portion for guiding the medical elongated body to one of a plurality of branch destinations at the branch portion of the lumen, Since the surgeon can easily insert the medical long body into a desired branch destination, the operability is excellent.
  • the medical elongate body has an orientation information detection unit for detecting the orientation of the medical elongate body, and the pre-acquired information includes an orientation of the lumen in the passage route. If so, the orientation of the medical elongate body and the direction of the lumen through which the medical elongate body passes are substantially equal, so that the direction of the lumen through which the medical elongate body passes, and By comparing the direction of the lumen with the direction of the lumen acquired in advance, it is possible to predict whether or not the passage route of the medical elongated body will reach the target portion of the lumen. It is possible to accurately guide various treatment tools along the long body for the medical treatment, and the long medical body.
  • the direction information detection unit detects the direction of gravity, the direction of the medical elongated body can be easily predicted based on the direction of gravity.
  • the orientation information detection unit is a substance enclosing unit in which a plurality of substances having different specific gravities are encapsulated. If the direction of gravity is detected, the direction of the medical elongated body can be easily predicted based on the direction of gravity. .
  • the direction information detecting unit detects the geomagnetic direction, it is easy to predict the direction of the medical elongated body based on the geomagnetic direction.
  • the orientation information detection unit detects a rotation angle around the axis of the medical elongated body
  • the orientation of the medical elongated body can be predicted from the rotational angle.
  • the orientation of the medical elongated body can be predicted without providing a configuration for detecting the orientation of the medical elongated body at the distal end portion. Therefore, the configuration of the distal end portion of the medical elongated body can be simplified, and as a result, the insertion of the medical elongated body into the lumen is easier.
  • the orientation information detection unit includes a magnetic flux generation unit that generates a magnetic flux in the axial direction of the medical elongated body
  • the traveling direction of the medical elongated body can be directly known from the direction of the magnetic flux. Therefore, the passage route of the medical long body can be predicted with higher accuracy.
  • the medical long body further includes a detection wave transmitting / receiving unit that transmits and receives a detection wave in the lumen, and the information processing unit is based on the detection wave received by the medical long body.
  • Generating a two-dimensional tomographic image of the lumen, calculating a branching angle of the branching portion of the lumen as information on the passage route based on the two-dimensional tomographic image, and the information acquired in advance is If the branch angle of the branch portion of the lumen is included, the calculated branch angle of the branch portion and the branch angle of the branch portion of the lumen acquired in advance are collated, so that the medical long body Therefore, it is possible to more accurately guide various treatment tools along the medical long body, and thus along the medical long body.
  • the information processing unit may further calculate a diameter of the lumen before and after branching based on the two-dimensional tomographic image, and the previously acquired information may include the diameter of the lumen before and after branching.
  • the medical long body further includes a detection wave transmitting / receiving unit that transmits and receives a detection wave in the lumen, and the information processing unit is based on the detection wave received by the medical long body.
  • Generating a two-dimensional tomographic image of the lumen, and calculating a branching direction of the branching portion of the lumen as information on the passage route based on the two-dimensional tomographic image By including the branching direction of the branching portion of the lumen, the calculated branching direction of the branching portion is collated with the branching direction of the branching portion of the lumen that has been acquired in advance. Therefore, it is possible to more accurately guide various treatment tools along the medical long body, and thus along the medical long body.
  • the information processing unit generates a two-dimensional tomographic image of the medical elongated body based on the detection wave, and the two-dimensional tomographic image of the medical elongated body rotates around the detection wave transmitting / receiving unit. If it is made asymmetric, it is easy to understand how the medical elongated body rotates around the axis from the two-dimensional tomographic image of the medical elongated body, so that the orientation of the medical elongated body can be predicted. easy.
  • the breathing area navigation system includes a detection unit that detects a rotation angle about the axis of the medical elongated body, and the information acquired in advance is stored in a branch destination tube in the branching unit of the lumen. If the direction of the cavity is included, the direction of the medical elongated body can be predicted from the rotation angle. Therefore, a configuration for detecting the direction of the medical elongated body is provided at the distal end of the medical elongated body. Without it, the orientation of the medical long body can be predicted. Therefore, the configuration of the distal end portion of the medical elongated body can be simplified, and as a result, the insertion of the medical elongated body into the lumen is easier.
  • the detection unit has a structure for rotating the distal end portion of the medical elongated body by following the rotation of the proximal end portion of the medical elongated body, the base of the medical elongated body is provided. Since the difference between the rotation angle of the end portion and the rotation angle of the distal end portion can be suppressed, the orientation of the medical elongated body can be further changed from the rotation of the proximal end portion of the medical elongated body compared to the case without such a structure. Predict accurately.
  • FIG. 3 is a cross-sectional view taken along the line 3-3 in FIG. 2, changing the direction of the medical elongated body. It is a schematic diagram which shows a mode that the two-dimensional tomographic image of a lumen
  • the navigation system 10 for respiratory region of 1st Embodiment has the elongate medical body 12 which has flexibility and is inserted in the lumen 30 which branches ahead from a trachea.
  • the navigation system 10 for breathing area includes a scanner 15 connected to the proximal end of the medical long body 12, an information processing unit 14 connected to the medical long body 12 via the scanner 15, and an information processing unit 14.
  • a display unit 16 connected to the.
  • the display unit 16 is, for example, a cathode ray tube, a liquid crystal display, or a plasma display.
  • the lumen 30 includes the trachea, main bronchus, lobe bronchus, bronchi, bronchiole, terminal bronchiole, respiratory bronchiole, alveolar duct (alveolar passage), alveoli, and alveolar sac, Only a portion of the entire lumen 30 is shown.
  • the medical long body 12 is a long body portion 128 having flexibility, and the orientation of the medical long body 12 provided in the main body portion 128 is detected.
  • the long medical body 12 includes a first lumen 121 that penetrates the main body 128 in the axial direction, and a second lumen 122 that does not open at the distal end side.
  • the first lumen 121 is provided with a guide wire 17.
  • the second lumen 122 includes a detection wave transmission / reception unit 123 that transmits and receives detection waves.
  • the main body 128 is made of, for example, a polymer material having excellent flexibility such as polyurethane, polyolefin, polyester, polyvinyl chloride, polycarbonate, polysulfone or silicone.
  • the outer diameter of the main body 128 is, for example, 1.0 to 2.0 mm.
  • the guide wire 17 protrudes from the opening at the tip of the first lumen 121.
  • the tip portion 170 (guide portion) of the protruding guide wire 17 is bent.
  • the guide wire 17 can be inserted into and removed from the first lumen 121 from a port 127 communicating with the proximal end opening of the medical elongated body 12.
  • a treatment instrument such as a deaeration needle, forceps, brush, microwave antenna, and radio wave electrode, or a diagnostic instrument such as an endoscope and an ultrasonic image sensor are connected from the port 127 to the first lumen 121. Can be inserted and removed.
  • the detection wave transmitting / receiving unit 123 is a sphere formed integrally with the optical fiber 124 on the distal end side of the optical fiber 124 and the optical fiber 124 that transmits light as a detection wave to the distal end side or the proximal end side of the long medical body 12.
  • An optical lens 125 and an optical mirror 126 formed by cutting off a part of the optical lens 125 are provided.
  • the optical fiber 124 As the optical fiber 124, a known one can be used.
  • the optical fiber 124 can be made of SiO 2 or plastic, and the optical fiber 124 has a layer structure including a core through which light passes and a clad surrounding the core.
  • the optical lens 125 and the optical mirror 126 emit light having traveled through the optical fiber 124 with an exit angle ⁇ with respect to the axial direction of the optical fiber 124.
  • the detection wave transmission / reception unit 123 has a viewing angle ⁇ around the emission angle ⁇ .
  • the optical lens 125 and the optical mirror 126 advance incident light incident from the outside along the optical fiber 124 toward the base end side.
  • the incident light is scattered, reflected, or refracted from the light emitted from the detection wave transmitting / receiving unit 123 and returned to the optical lens 125.
  • the scanner 15 is connected to the optical fiber 124, guides the light source to the optical fiber 124, and can communicate incident light to the information processing unit 14.
  • the scanner 15 rotates (radially scans) the detection wave transmission / reception unit 123 around the optical fiber 124 at a scanning angle of 360 ° around the central axis of the optical fiber 124.
  • the orientation information detection unit 11 has a hollow ring shape along the outer periphery of the main body 128.
  • the orientation information detection unit 11 is a substance enclosure that encloses a first substance 111 and a second substance 112 having different specific gravities.
  • the first substance 111 is lighter in specific gravity than the second substance 112.
  • the first substance 111 is, for example, a gas such as air, nitrogen gas, argon gas, or a liquid such as silicone oil.
  • the second substance 112 is a ball formed of a liquid such as silicone oil or a metal material such as titanium.
  • the substance 111 and the second substance 112 move so as to be arranged in order of the second substance 112 and the first substance 111 from the lower side in the gravity direction due to the difference in specific gravity.
  • the liquid indicates the direction of gravity by arranging the liquid and gas in this order from the lower side in the direction of gravity.
  • the titanium ball indicates the direction of gravity by arranging the titanium ball and the liquid in this order from the lower side in the direction of gravity.
  • the first material 111 and the second material 112 are arranged in the order of the second material 112 and the first material 111 from the lower side in the direction of gravity, so that the direction information detection unit 11 detects the direction of gravity.
  • the orientation information detection unit 11 is disposed at the distal end of the medical elongated body 12. In addition, the orientation information detection unit 11 is within the irradiation range of light emitted from the detection wave transmission / reception unit 123 (within the detection wave transmission range).
  • the light irradiation range is a range in which light defined by the above-described emission angle ⁇ , viewing angle ⁇ , and scanning angle (360 °) is irradiated.
  • the information processing unit 14 includes a CPU and a storage device such as a memory and a hard disk as main components.
  • the information processing unit 14 is a light source that is optically connected to the optical fiber 124 via the scanner 15 and supplies light to the optical fiber 124, a reference mirror that generates reference light for reference to incident light, and an optical fiber And a photodetector such as a photodiode for detecting incident light traveling through 124.
  • the information processing unit 14 uses a known optical coherence tomography (OCT) based on incident light incident on the detection wave transmission / reception unit 123 based on a two-dimensional tomographic image of the lumen 30 and the medical elongated body 12. Is generated.
  • OCT optical coherence tomography
  • FD-OCT frequency domain optical coherence tomography
  • a two-dimensional tomographic image of the scale 12 can also be obtained.
  • the two-dimensional tomographic images of the lumen 30 and the medical elongated body 12 generated by the information processing unit 14 are displayed in a circular imaging window W on the display unit 16.
  • the image of the detection wave transmitting / receiving unit 123 is located at the center of the imaging window W.
  • the surgeon can know the direction of gravity (the direction indicated by the second substance 112) from the displayed image of the orientation information detection unit 11.
  • the tomographic image of the main body 128 of the medical elongated body 12 is rotationally asymmetric around the detection wave transmitting / receiving unit 123 that is the center of the image, the surgeon can It can be seen how the elongate body 12 rotates about the axis.
  • the surgeon can predict in which direction the guide unit 17 is directed, and thus the orientation of the medical long body 12 can be known.
  • the direction of the lumen 30 through which the medical long body 12 passes is substantially the same as the direction of the medical long body 12, the surgeon can use the lumen 30 through which the medical long body 12 passes. You can know the direction.
  • That the cross section of the medical elongated body 12 is rotationally asymmetric around the detection wave transmitting / receiving unit 123 means that the cross sections of the medical elongated body 12 are only rotated when the cross section of the medical elongated body 12 is rotated 360 ° around the detection wave transmitting / receiving unit 123. Means overlapping.
  • the information processing unit 14 is, for example, a three-dimensional image (for the structure of the lumen) of the lumen 30 acquired in advance by ultrasound, MRI (Magnetic Resonance Imaging), CT (Computed Tomography), PET (Positron Emission Tomography), or the like. (Information acquired in advance) is stored.
  • the information processing unit 14 stores a guide route 31 from the opening communicating with the lumen 30 such as the mouth or the nose to the lesioned portion 32 of the lumen 30, as shown in FIG.
  • the guide route 31 can be displayed on the display unit 16 so as to overlap the acquired three-dimensional image of the lumen 30 (only a part of the guide route 31 is shown in FIG. 7). Since the calculation of the guide route 31 is based on a conventionally known technique, a description thereof is omitted here.
  • the guide method of the medical elongated body 12 includes an insertion step of advancing the medical elongated body 12 to the bifurcation, information on the passage route of the medical elongated body 12 and the structure of the lumen 30 after the insertion step.
  • the surgeon introduces the medical elongated body 12 into the lumen 30 through an opening such as a patient's mouth or nose.
  • the operator advances the medical long body 12 to the branching portion while confirming the two-dimensional tomographic images of the lumen 30 and the medical long body 12 on the display unit 16.
  • the two-dimensional tomographic image of the lumen 30 is substantially circular in the substantially linear portion of the lumen 30, and the number thereof is one.
  • the two-dimensional tomographic image of the lumen 30 changes to an ellipse at the branch start portion and is divided into a plurality at the branch end portion. Therefore, the surgeon can determine from the change in the two-dimensional tomographic image of the lumen 30 whether the medical elongated body 12 has reached the bifurcation.
  • the surgeon advances the medical long body 12 to one of a plurality of branch destinations in the branch portion, and displays a two-dimensional tomographic image on the information processing section 14.
  • the branch angle of the branch portion is calculated.
  • the calculation method of the branch angle is as described above.
  • the information processing unit 14 displays the calculated branch angle on the display unit 16.
  • the operator reads the direction of the lumen 30 from the two-dimensional tomographic images of the lumen 30 and the medical elongated body 12.
  • the operator reads the orientation of the medical elongated body 12 from the two-dimensional tomographic image of the lumen 30 and the medical elongated body 12 displayed on the display unit 16.
  • the orientation of the medical elongated body 12 may be calculated from a two-dimensional tomographic image of the lumen 30 and the medical elongated body 12 by a known image processing technique.
  • the two-dimensional tomographic image (information relating to the passage route) obtained by the information processing unit 14 and the branching angle (information relating to the passage route) of the branching unit, as well as the direction of the lumen 30 that can be read from the two-dimensional tomographic image Information) is collated with the two-dimensional tomographic image of the lumen 30 acquired in advance, the branching angle of each branching portion, and the direction of the lumen 30.
  • the two-dimensional tomographic image of the lumen 30 acquired in advance, the branching angle of each branching portion, and the direction of the lumen 30 can be read from the three-dimensional image of the lumen 30 acquired in advance.
  • the two-dimensional tomographic image of the cavity 30, the branching angle of the branching portion, and the direction of the lumen 30 can be read from the three-dimensional image of the lumen 30 acquired in advance.
  • the surgeon collates the change in the two-dimensional tomographic image and the change in the direction of the lumen 30 when the medical elongate body 12 passes through the bifurcation, and the branching angle with previously acquired information, It can be predicted how many branches the medical elongated body 12 currently reaches.
  • the surgeon collates the branch angle calculated by the information processing unit 14 with the branch angle of each branch unit acquired in advance, so that the medical long body is in the first branch unit. 12 can be predicted.
  • surgeon has acquired in advance a two-dimensional tomographic image of the lumen 30 obtained before the medical elongate body 12 passes through the bifurcation and a two-dimensional tomographic image of the lumen 30 obtained after the passage.
  • the surgeon can obtain the orientation of the lumen 30 obtained before passage of the branch portion of the medical long body 12 and the orientation of the lumen 30 obtained after passage of the branch portion before and after passing through each branch portion.
  • the medical long body 12 can be predicted to reach the current branching portion.
  • the bifurcation angle can be accurately determined by comparing the bifurcation angle of the bifurcation portion, the change in the two-dimensional tomographic image of the lumen 30 before and after passage through the bifurcation portion, and the change in the orientation of the lumen 30. Predictable.
  • the branching portion can be predicted from any one of the branching angle of the branching portion, the change in the two-dimensional tomographic image of the lumen 30 before and after passing through the branching portion, and the change in the direction of the lumen 30, By specifying the branch part from the information, the branch part can be predicted more accurately.
  • the surgeon After identifying the bifurcation where the medical elongate body 12 has reached, the surgeon changes the two-dimensional tomographic image of the lumen 30 before and after passing through the bifurcation and the change in the direction of the lumen 30, or of these By comparing one of these with the information acquired in advance at the specified branching portion, it is determined which of the plurality of branch destinations at the branching portion has the medical long body 12 inserted. . Since the collation of the obtained information and the information acquired in advance is the same as described above, the description is omitted.
  • the surgeon advances the medical long body 12 as it is. If the branch destination into which the medical long body 12 is inserted is different from the branch destination through which the guide path 31 passes, the medical long body 12 is pulled back, and the medical long body 12 is attached to another branch destination. insert.
  • the process moves to the next insertion process.
  • the medical elongate body 12 is guided according to the guidance path
  • the surgeon refers to the two-dimensional tomographic images of the main body 128 and the orientation information detection unit 11 obtained by the information processing unit 14, so that the orientation of the medical elongated body 12 can be determined.
  • the medical elongate body 12 passes from the direction of the medical elongate body 12.
  • the direction of the existing lumen 30 is known. Then, by comparing the direction of the lumen 30 with the previously acquired direction of the lumen 30, the path through which the medical elongate body 12 passes can reach the target site of the lumen 30. Therefore, it is possible to accurately guide various treatment tools along the long medical body 12 and thus along the long medical body 12.
  • the branch angle of the branching portion reached by the medical elongated body 12 is calculated, and the branch is obtained.
  • the passage route of the medical elongated body 12 can be more accurately determined. Since the prediction can be made, various treatment tools can be guided more accurately along the long medical body 12 and thus along the long medical body 12.
  • the medical elongated body 12 is obtained from the two-dimensional tomographic image of the medical elongated body 12. It is easy to understand how it rotates about the axis, and thus it is easy to predict the orientation of the medical elongated body.
  • the direction information detection unit 11 detects the direction of gravity, it is easy to predict the direction of the medical elongated body 12 with reference to the direction of gravity.
  • the direction information detection unit 11 is a substance enclosure unit that encloses two substances 111 and 112 having different specific gravities and is within the transmission range of the detection wave, a detection wave for obtaining a two-dimensional tomographic image is used. Can detect the direction of gravity.
  • distal end portion 170 of the guide wire 17 makes it easy for the operator to insert the medical long body 12 into a desired branching destination, so that the operability is excellent.
  • the navigation system 40 for breathing area of the second embodiment is substantially the same as that of the first embodiment, but includes a roller encoder 41 (length information acquisition unit) in contact with the medical long body 12. It differs from the first embodiment in that it has.
  • 2nd Embodiment is as substantially the same as 1st Embodiment, the overlapping description is abbreviate
  • the roller encoder 41 rotates as the medical elongated body 12 advances and retreats, and the distal end of the medical elongated body 12 inserted into the lumen 30 (part of the portion inserted into the lumen), for example, the mouth Alternatively, it is possible to measure the length between the opening (communication position in the passage of the medical elongated body) communicating with the lumen 30 such as the nose, that is, the insertion length of the medical elongated body 12.
  • the roller encoder 41 is electrically connected to the information processing unit 14, and sends the measured length to the information processing unit 14.
  • the operator can use the tube from the opening.
  • the length along the lumen 30 up to an arbitrary position of the cavity 30 can be known. Therefore, the surgeon compares the length measured by the roller encoder 41 with the length of the lumen 30 acquired in advance, and to what position of the lumen 30 the medical elongated body 12 has reached. Predictable.
  • the guide method for the medical elongated body 12 of the second embodiment is substantially the same as that of the first embodiment, and includes an insertion step, a collation step, and a branch selection step.
  • the branch angle by the information processing unit 14 in the insertion step The calculation method is different from that of the first embodiment.
  • the information processing unit 14 detects the displacement L ⁇ b> 3 of the medical elongated body 12 at the branching portion measured by the roller encoder 41 and the surface S ⁇ b> 1. From the distance L4 between the centers of the branch destinations 31 and 32 obtained from the two-dimensional tomographic image, the branch angle is calculated by the following equation (2).
  • the collation process is different from that in the first embodiment.
  • the insertion length of the medical elongated body 12 is collated in addition to the two-dimensional tomographic image, the branch angle, and the direction of the lumen 30.
  • the second embodiment from the insertion length of the medical elongated body 12 measured by the roller encoder 41 and the opening as the reference position stored in the information processing section 14 in the collating process. The distance to each branch of the lumen 30 is collated.
  • the length of the medical elongated body 12 inserted in the lumen 30 is acquired in advance.
  • the length of the existing lumen 30 it is possible to more accurately predict the passage route of the medical elongated body 12 in the lumen 30, and in addition to the effects of the first embodiment, the medical elongated body 12.
  • the navigation system 50 for a respiratory region according to the third embodiment is different from the second embodiment in that it includes a detection unit 19 that detects the rotation angle around the axis of the medical elongated body 52.
  • the respiratory area navigation system 50 according to the third embodiment includes a rotary encoder 18 that detects a rotation angle around the axis of the medical elongated body 52 as an orientation information detection unit instead of the substance enclosure unit 11. This is different from the second embodiment.
  • 3rd Embodiment is as substantially the same as 2nd Embodiment, the overlapping description is abbreviate
  • the detection unit 19 includes the rotary encoder 18 and also includes a structure 120 that rotates the distal end portion 170 (guide portion) of the guide wire 17 in accordance with the rotation of the proximal end portion of the medical elongated body 52.
  • the rotary encoder 18 is an optical type.
  • the rotary encoder 18 includes a disk-shaped scale 180 fixed along the outer periphery of the proximal end portion of the medical elongated body 52, and a light emitting element 181 and a light receiving element 182 arranged so as to sandwich the scale 180.
  • a plurality of slits arranged along the outer periphery of the medical elongated body 52 are formed in the scale 180.
  • the proximal end portion of the long medical body 52 is connected to the scanner 15 so as to be rotatable about an axis.
  • the scale 180 rotates together with the medical long body 52.
  • the light emitted from the light emitting element 181 is repeatedly passed and shielded.
  • the light receiving element 182 detects the repetition of light and dark in proportion to the rotation angle around the axis of the medical elongated body 52 and detects the electrical signal.
  • Output as.
  • the light receiving element 182 and the information processing unit 14 are electrically connected, and a signal from the light receiving element 182 is sent to the information processing unit 14.
  • the information processing unit 14 displays the detected rotation angle around the axis on the display unit 16.
  • the surgeon knows the orientation of the distal end portion 170 of the guide wire 17 when introduced into the opening communicating with the lumen 30 such as the mouth or nose, that is, the orientation of the medical elongated body 52. Further, the surgeon knows how the orientation of the medical elongated body 52 has changed from the rotation angle detected by the rotary encoder 18. Therefore, the surgeon can predict the orientation of the medical elongated body 52 in the lumen 30 from the rotation angle detected by the rotary encoder 18.
  • the surgeon changes the orientation of the medical elongated body 52 along the guide path 31 by rotating the medical elongated body 52 around the axis while confirming the rotation angle detected by the rotary encoder 18, and The medical elongated body 52 is advanced to the target site.
  • a reinforcing body 120 extending from the proximal end to the distal end of the medical long body 52 is a medical long
  • the structure provided in the body 52 is mentioned.
  • the reinforcing body 120 has, for example, a structure in which a pipe is spirally cut, a structure in which a thin metal wire or the like is wound in a coil shape or braided in a mesh shape, and a plurality of metal wires are parallel and in contact with each other And a structure in which a highly rigid substance is placed from the base end portion to the tip end portion.
  • These reinforcing bodies 120 may be devised so that the flexibility increases from the base end portion toward the tip end portion as necessary. Such a contrivance is realized, for example, by gradually narrowing the pitch between the cuts from the base end portion toward the tip end portion in a structure in which the pipe is cut spirally.
  • the structure for the distal end portion 170 of the guide wire 17 to follow the rotation on the proximal end side is not necessarily limited to the structure in which the reinforcing body 120 is provided on the medical elongated body 52, and the proximal end to the proximal end portion.
  • the structure may be such that the physical properties of the medical elongated body 52 gradually change over the portion.
  • the structure in which the rigidity of the medical elongated body 52 is gradually reduced from the proximal end side to the distal end side allows the distal end portion 170 of the guide wire 17 to follow the rotation of the proximal end portion of the medical elongated body 52. It is valid.
  • the medical long body 52 is formed by integrally connecting tubes having different rigidity arranged in the axial direction.
  • the long body 52 has a portion where the rigidity changes greatly (in this example, a connection portion between pipe bodies having different rigidity)
  • the portion bent toward the distal end side than the portion where the rigidity changes greatly is present.
  • the distal end portion of the medical elongated body 52 does not follow the rotation of the proximal end portion of the medical elongated body 52, and as a result, a situation occurs in which rotational force is accumulated in the medical elongated body 52. obtain.
  • the accumulated force is suddenly released when the threshold is exceeded, and is expected to damage the lumen 30 to cause rotation of the distal end of the medical elongated body 52 and the distal end 170 of the guidewire 17.
  • the medical elongated body 52 has a structure in which the rigidity is gradually reduced from the base end portion to the distal end portion.
  • the rigidity gradually changes, as shown in FIG. 13, the unit length of the resistance load from the flexible portion A on the distal end side to the high rigidity portion B on the proximal end side of the long medical body 52 ( It means that the rate of increase per mm) does not exceed 75%.
  • the horizontal axis L is the axial position (distance) from the distal end to the proximal end of the medical elongated body 52
  • the vertical axis F is the medical elongated body 52 at the corresponding axial position.
  • Resistance load (N) is one index indicating the level of rigidity at each axial position of the medical elongated body 52, for example, a two-point support beam (the distance between the two points is, for example, 25.4 mm).
  • the measurement position of the medical elongated body 52 is arranged at the center of the center, and an arbitrary pressing distance (for example, 0.2 mm, pressing speed is, for example, 5 mm / min) in a direction orthogonal to the axial direction with respect to the measurement position
  • the load resistance (N) when an indentation load is applied is measured.
  • the guide method for the medical elongated body 52 according to the third embodiment includes an insertion step, a collation step, and a branch selection step as in the second embodiment. In the second embodiment and the third embodiment, these methods are used. There are differences in each process.
  • the insertion length of the medical elongated body 52 that has reached the branching portion is acquired, and the medical lengthwise length from the reaching branching portion to one of a plurality of branching destinations.
  • the branching angle of the branching section, the two-dimensional tomographic image before and after passing through the branching section, and the direction of the lumen 30 are acquired.
  • these are collated with information acquired in advance, so that it is determined what number the branch portion of the medical elongated body 52 has reached from the reference position such as the mouth.
  • the medical elongated body 52 It is judged from the two-dimensional tomographic images before and after passing through the section and the direction of the lumen 30 to which branch destination in the branch section the medical elongated body 52 is inserted.
  • the branch selection step if the branch destination into which the medical long body 52 is inserted is the branch destination along the guide path 31, the medical long body 52 is advanced as it is, and the medical long body 52 is inserted. If the branch destination is not the branch destination along the guide route 31, the medical elongated body 52 is returned to the branch portion and then advanced to another branch destination.
  • the medical long body 52 that has reached the branch portion is not inserted into one of the plurality of branch destinations, and therefore, the branch angle of the branch portion and the passage through the branch portion Without acquiring the later two-dimensional tomographic image and the orientation of the lumen 30, the insertion length of the medical elongated body 52 that has reached the bifurcation, the two-dimensional tomographic image before passing the bifurcation and the orientation of the lumen 30 Is obtained, and then, in the collation step, these are collated with information obtained in advance to determine what number the branch portion of the medical elongated body 52 has reached from the reference position. .
  • the surgeon matches the direction of the distal end portion 170 of the guide wire 17 with the direction of the lumen 30 of the branch destination through which the guide path 31 passes in the branch portion, and the medical long length to the branch destination. Insert body 52.
  • each process of the guidance method of 3rd Embodiment is described.
  • the operator performs the insertion length of the medical elongated body 52 measured by the roller encoder 41, the rotation angle around the axis of the medical elongated body 52 detected by the rotary encoder 18, and the lumen. 30 and the medical long body 52 are inserted until reaching the bifurcation while confirming the two-dimensional tomographic images of the medical long body 52.
  • the insertion length of the medical elongated body 52 measured by the roller encoder 41 is used. The surgeon can determine whether or not the medical elongated body 52 has reached the bifurcation. Further, since the two-dimensional tomographic image of the lumen 30 changes to an ellipse at the branch start portion, the operator can determine whether or not the medical elongated body 52 has reached the branch portion.
  • the operator determines the insertion length of the medical elongated body 52 measured by the roller encoder 41 and the length of the lumen 30 acquired in advance from the reference position to each branch portion. By collating, it is determined what numbered branch portion the medical elongated body 52 has reached from the reference position.
  • surgeon confirms the direction of the branch destination through which the guide path 31 passes at the branch portion where the medical long body 52 has reached from a three-dimensional image of the lumen 30 acquired in advance, and also rotary.
  • the actual orientation of the medical elongated body 52 is confirmed from the rotation angle detected by the encoder 18.
  • the surgeon rotates the medical elongated body 52 around the axis while checking the rotation angle, so that the distal end portion of the guide wire 17 substantially matches the direction of the branch destination to be advanced. Change the direction of 170. That is, the surgeon selects a branch destination along the guide route 31. When the direction of the distal end portion 170 of the guide wire 17 substantially matches the direction of the branch destination to be advanced, the surgeon advances the medical elongated body 52 to the branch destination and executes the next insertion step.
  • the orientation of the medical elongated body 52 can be predicted from the rotation angle.
  • the orientation of the medical elongated body 52 can be predicted without providing a configuration for detecting the orientation of the medical elongated body 52 like the substance non-entry portion 11 at the distal end of the medical elongated body 52. Therefore, the respiratory navigation system 50 of the third embodiment can simplify the configuration of the distal end portion of the medical elongated body 52.
  • the medical device for the lumen 30 can be used. There exists an effect that insertion of the elongate body 52 is easier.
  • the length of the medical long body 52 is smaller than that without the reinforcing body 120.
  • the direction of the medical elongated body 52 can be predicted more accurately from the rotation of the proximal end portion.
  • the navigation system 60 for the respiratory region of the fourth embodiment is substantially the same as the navigation system 40 for the respiratory region of the second embodiment, but the information processing unit 14 is a branching unit as information on the passage route. This is different from the second embodiment in that the branch direction of the branch portion is calculated instead of calculating the branch angle.
  • the guidance method of the fourth embodiment has an insertion process, a collation process, and a branch selection process, as in the second embodiment.
  • the second embodiment and the present embodiment are different in the insertion process and the collation process. There is a point.
  • the operator inserts the medical long body 12 up to the branch portion by the same operation as in the second embodiment, and to one of a plurality of branch destinations branched from the branch portion.
  • the branch direction of the branch portion is calculated instead of the branch angle of the branch portion.
  • the branching direction of the branching portion is the direction of a vector connecting the centers of the two annular cross sections of the branched lumen 30.
  • the branch direction of the branch portion is calculated based on the two-dimensional tomographic image of the lumen 30.
  • the two-dimensional tomographic image of the lumen 30 changes from a circular shape to an ellipse as the medical elongated body 12 advances from the linear portion of the lumen 30 to the branching portion. Changes from an ellipse to a plurality of annular cross-sections as it proceeds to one of a plurality of branch destinations.
  • the branching direction of the branching part is calculated based on two annular cross sections of the branched lumen 30 in the two-dimensional tomographic image of the lumen 30 that changes in this way.
  • the surgeon stops the advancement of the medical elongated body 12 when the two annular sections of the branched lumen 30 can be confirmed on the display unit 16, and causes the information processing unit 14 to calculate the branch direction.
  • the information processing unit 14 displays the entire two-dimensional tomographic image of the lumen 30 in the imaging window W so that the gravity direction G detected by the orientation information detection unit 11 is on the display unit 16. (FIG. 14 shows the state after rotation).
  • the information processing unit 14 After the rotation, the information processing unit 14 has the medical long body 12 inserted from the center of the annular tomogram 34 of the two branch destinations 33 and 34 where the medical long body 12 is not inserted.
  • the vector V toward the center of the other 33 tomographic images is calculated.
  • the direction of the vector V is the branch direction of the branch portion.
  • the two-dimensional tomographic image, the direction of the lumen 30, and the insertion length of the medical elongated body 12 are verified as in the second embodiment, but the direction of the vector V is verified instead of the branch angle. Is done.
  • the direction of the calculated vector V is collated with the branching direction of each branching part that can be read from the three-dimensional image of the lumen 30 that has been acquired in advance. It can be determined what number branch part the scale 12 currently reaches.
  • the branch direction of the branch portion is verified instead of the branch angle, and the effect of being able to determine which branch portion the medical elongated body 12 has reached from the comparison result is first described.
  • the respiratory navigation system 60 has the same operational effects as the respiratory navigation system 40 of the second embodiment.
  • the information processing unit 14 may calculate the diameter of the lumen 30 before and after branching of the branch portion based on the generated two-dimensional tomographic image of the lumen 30.
  • the information processing unit 14 calculates the diameter of the lumen 30 from the two-dimensional tomographic image of the one lumen 30 before the medical elongated body 12 passes through the branch portion. In addition, the information processing unit 14 calculates the diameter of each lumen 30 from the two-dimensional tomographic image of each of the plurality of branched lumens 30 after or after the medical long body 12 passes through the branching portion. Calculate the diameter or major axis.
  • the information processing unit 14 displays the calculated diameter of the lumen 30 before and after the branching on the display unit 16.
  • the surgeon collates the displayed calculation result with the diameter before and after the branching of the corresponding branching part, which can be read from the three-dimensional image of the lumen 30 acquired in advance, so that the medical elongated body 12 is Predict which of a plurality of branch destinations has been passed.
  • the passage route of the medical elongated body can be predicted with higher accuracy.
  • the orientation information detection unit may be a magnetic flux generation unit 91 that generates a magnetic flux in the axial direction of the medical elongated body.
  • the magnetic flux generation unit 91 is, for example, a magnet provided on the medical long body 92.
  • the magnetic flux generator 91 may be a coil.
  • the respiratory navigation system 90 includes magnetic flux detection units 93, 94, and 95 that detect magnetic flux.
  • the magnetic flux detectors 93, 94, and 95 are arranged so as to be positioned on three axes that intersect each other.
  • the magnetic flux detection part 94 is arrange
  • the magnetic flux detector 93 is arranged so as to be located on an axis extending from the chest of the patient to the back (or vice versa).
  • the magnetic flux detector 95 is arranged so as to be located on an axis substantially orthogonal to these two axes.
  • the magnetic flux detectors 93, 94, and 95 are, for example, magnetic flux vector sensors in which a Hall sensor, a magnetoresistive element, a magnetic impedance element, and a search coil are arranged on three intersecting axes.
  • the magnetic flux detectors 93, 94, and 95 detect the direction of the magnetic flux, respectively.
  • the direction of the magnetic flux from the magnetic flux generator 91 is detected three-dimensionally by the three magnetic flux detectors 93, 94, and 95. Moreover, since the magnetic flux generation part 91 produces the magnetic flux of the axial direction of the medical elongate body 92, the advancing direction of the medical elongate body 92 can be estimated from the direction of the detected magnetic flux.
  • the magnetic flux detection units 93, 94, and 95 are electrically connected to the information processing unit 14. Signals detected by the magnetic flux detection units 93, 94, and 95 are sent to the information processing unit 14. The information processing unit 14 processes signals from the magnetic flux detection units 93, 94, and 95 and three-dimensionally displays the traveling direction of the medical elongated body 92 on the display unit 16.
  • the orientation information detection unit is a magnetic flux generating unit that generates a magnetic flux in the axial direction of the medical elongated body
  • the medical elongated body can be detected from two-dimensional tomographic images and rotation around the axis.
  • the traveling direction of the medical elongated body can be directly understood from the direction of the magnetic flux, so that the passage route of the medical elongated body can be predicted with higher accuracy.
  • the approximate position of the tip of the medical elongated body can be known by the magnetic flux generator, the path of the medical elongated body can be predicted with higher accuracy.
  • the orientation information detection unit may detect a geomagnetic direction such as an electronic compass.
  • a geomagnetic direction such as an electronic compass.
  • the geomagnetic direction is detected instead of the gravity direction. In this case, it is easy to predict the direction of the medical long body based on the geomagnetic direction.
  • the orientation information detection unit may be an optical fiber gyro 71 provided so as to be wound around the axis of the medical long body as shown in FIGS. 17 and 18.
  • the rotation angle around the axis of the medical elongated body 72 can be detected by the optical fiber gyro 71, and the orientation of the medical elongated body 72 is determined from the rotation angle around the axis of the medical elongated body 72 as in the third embodiment. Can be predicted.
  • the length information acquisition unit is the roller encoder 41, but the present invention is not limited to this. That is, the length information acquisition unit only needs to be able to measure the insertion length.
  • the length information acquisition unit may be a scale printed on the outer surface of the medical elongated body and aligned along the axial direction of the medical elongated body. .
  • the medical elongated body does not have the first lumen 121, and the portion where the first lumen 121 is provided may be solid.
  • a treatment tool used for treatment of a lesioned part or the like is guided along the medical elongated body outside the medical elongated body.
  • a diameter can be made smaller and insertion operation in a lumen
  • the present invention is not limited to this, and any wave applicable to detection, such as an ultrasonic wave, a magnetic field, or a sound, can be applied as the detection wave.
  • the guide portion is the bent distal end portion 170 of the guide wire 17, but the present invention is not limited to this.
  • the distal end of the main body portion 128 of the medical elongated body may be reduced in diameter toward the distal end side in the axial direction, or the distal end of the main body portion 128 of the medical elongated body may be bent. It may be a thing.
  • the present invention includes the respiratory system navigation system 50 according to the third embodiment in which the reinforcing body 120 is omitted.
  • tip part of a medical elongate body is not provided by not providing the orientation information detection part 11 like the 1st Embodiment and 2nd Embodiment at the front-end
  • FIG. 19 and FIG. 20 the present invention is not limited to this. That is, as shown in FIG. 19 and FIG. 20, a form in which the orientation information detection unit 11 of the first embodiment or the second embodiment is added to the distal end portion of the medical long body 52 of the third embodiment is described. Includes.
  • the orientation of the medical elongated body 82 is predicted from the two-dimensional tomographic image of the lumen 30 in addition to the rotation angle around the axis of the medical elongated body 82, the medical elongated body is more accurately detected. 82 passage paths can be predicted.
  • a device that detects the geomagnetic direction such as an electronic compass, is applicable.
  • a medical long body may be inserted into the body using a guide sheath having a tube shape.
  • the operator inserts and fixes the guide sheath so as to reach from the outside of the nose to the lower part of the vocal cords, and inserts the medical long body there.
  • a roller encoder 41 is attached to the outer end of the guide sheath.
  • the surgeon can reduce the insertion length error by advancing the guide sheath to the bronchial periphery in accordance with the progress of the medical long body. For example, when the medical long body reaches the fifth branch and proceeds to the next sixth branch, the medical long body is advanced after the guide sheath is advanced to the fourth branch (may be the second branch to the fifth branch). By advancing, it is possible to know the distance traveled with high accuracy. By using the guide sheath, an error caused by the slack of the medical long body in the body can be reduced, and thus the advanced distance can be known with higher accuracy.
  • the movement distance more accurately by changing the reference point to a point confirmed in the middle and using the relative movement distance from the point instead of the absolute distance from the reference position of one point.
  • the first branch of the bronchus is corrected to the zero point regardless of the measurement reference position, and the distance from that is used.
  • the fourth branch is corrected to a zero point, and the number of millimeters advanced from there is used. By doing so, errors can be reduced.

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Abstract

Le problème à résoudre dans le cadre de la présente invention porte sur un système de navigation pour la respiration dans lequel un dispositif médical peut être guidé avec précision jusqu'au côté d'extrémité d'une lumière, de manière à permettre un traitement minimalement invasif dans la thérapie de la pneumonectasie, une biopsie etc. La solution consiste à procurer un système de navigation (10) pour la respiration comprenant les éléments suivants : un corps allongé (12) pour utilisation médicale, qui est flexible et doit être inséré dans une lumière ramifiée (30) située distalement à la trachée ; et une unité de traitement d'informations (14), qui est reliée au corps allongé pour un usage médical, acquiert des informations liées à la voie de passage du corps allongé pour un usage médical dans la lumière, et stocke des informations préalablement acquises qui sont liées à la structure de la lumière, comprenant au moins ladite voie de passage.
PCT/JP2012/071315 2011-08-31 2012-08-23 Système de navigation pour la respiration WO2013031637A1 (fr)

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