CN100446723C - 用于侵入性导管定位的光导系统 - Google Patents

用于侵入性导管定位的光导系统 Download PDF

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CN100446723C
CN100446723C CNB028124065A CN02812406A CN100446723C CN 100446723 C CN100446723 C CN 100446723C CN B028124065 A CNB028124065 A CN B028124065A CN 02812406 A CN02812406 A CN 02812406A CN 100446723 C CN100446723 C CN 100446723C
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light
conduit
patient
optical fiber
guiding system
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CN1602168A (zh
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戴维·F·威尔逊
格雷戈里·J·谢尔斯
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University of Pennsylvania Penn
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    • 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
    • A61B1/06—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 with illuminating arrangements
    • A61B1/07—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 with illuminating arrangements using light-conductive means, e.g. optical fibres
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A61B5/064—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/58—Means for facilitating use, e.g. by people with impaired vision
    • A61M2205/587—Lighting arrangements

Abstract

来自小激光二极管的光导入导管末端并穿过光纤，该光纤在制造时或者包含在管腔中或者包含到侵入性导管的壁内。光选择为具有被组织最少地吸收的波长，优选地在大约620nm到1100nm的范围内。优选地采用780nm，因为在该波长处组织吸收接近最小。光从光纤端部(位于导管近端)出来并经过组织到达患者皮肤外部，在这里它被检测。由夜视镜观察光带，该夜视镜滤出其他频率范围的光。所检测的光可以定位光纤端部，位置精度取决于光纤末端和体外之间的组织厚度。该方法对于儿童以及在成人皮肤表面几厘米内的导管具有很高的精度。

Description

用于侵入性导管定位的光导系统
相关申请的交叉引用
本申请要求2001年6月19日提交的60/299,299号美国临时专利申请的优先权。
技术领域
本发明涉及一种光导系统，以及一种用于插入气管内导管、鼻饲管、饲管、硬膜导管、中央静脉导管、外插式中央静脉导管、胸腔管多级导管、和类似的侵入性导管和管子的方法。
背景技术
确定插入到患者体内的导管的端部位置以便将营养素或药物提供到体内特定位置一直是个难题。目前，导管定位或者是没有视觉导向地进行，或者如果定位特别关键，则通过X射线来进行，X射线可以精确地确定用来制造管子的不透射线的塑料材料的位置。但是，通常需要大量的X射线。因此需要一种方便并容易使用并且还可以不需要X射线而能非常精确地定位导管端部的光学系统。优选地，在插入过程中可以直接观察导管端部的位置并且在其后的任何时候可以检查端部位置。
已经获知在先技术的导管光传输装置(例如Woodward等的5,947,958)，它在插入之后例如通过腹膜壁提供内部器官的照明。这种照明是或者为组织表面成像提供光或者为光动力性疗法传输光。这种装置不是用来导管定位的。
其他光导装置，例如Fontenot的5,423,321具有多个不同长度的光导纤维，在手术期间它们插入到内部器官或脉管中。在气囊导管的情况下，这种光导装置用于将气囊导管定位在必要时气囊充气以阻塞脉管的地方。导光装置是一个独立实体并且通过脉管壁进行观察，从而光线足够，尽管近红外光降低所需的光强度。还需要一个检测系统用来当手术刀具接近脉管时进行确定。
Vander Salm等的5,906,579和Duhaylongsod等的6,113,588类似地说明了一种在手术条件下通过脉管壁使气囊导管可见的方法。在这些装置中，光纤是一个独立实体并且优选地插入通过多管腔导管的一个管腔。所揭示的装置特别是用于心胸手术。
这些在先技术光导装置没有使用内置在导管中具有多种不同功能的单一光纤，不是主要用于定位气管内导管、鼻饲管、饲管、硬膜导管、中央静脉导管、外插式中央静脉导管、胸腔管多级导管、和类似的侵入性导管和管子的非手术过程中插入的导管的端部，并且这些在先技术光导装置没有仅仅使用近红外光，因为脉管在手术中并不外露并且可见光(蓝色到橙色)不能充分穿透组织。而且，这些在先技术光导装置相对昂贵并且要求光学组件接受FDA的苛刻审查，因为它门将接触患者。本发明克服了在先技术的这些局限。
发明内容
来自小激光二极管的光穿过光纤，该光纤在制造时或者包含在管腔中或者包含到侵入性导管的壁内。光选择为具有被组织最少地吸收的波长，优选地在大约620nm到1100nm的范围内。在一个优选实施例中，采用780nm，因为在该波长处组织吸收最小。光从光纤端部(位于导管末端)出来并经过组织到达外部，在这里它被检测。由夜视镜观察光带，该夜视镜滤出其他频率范围的光。所检测的光可以定位光纤端部，位置精度取决于光纤末端和体外之间的组织厚度。该方法对于儿童以及靠近成人皮肤表面的导管具有很高的精度，但是不可应用于放置在一些成人体腔内的导管。具体来说，本发明提供了一种用于在患者体内定位侵入性导管的光导系统，包括：导管；插入所述导管内从而延伸到所述导管的末端的光纤；以及在导管近端将光导入所述光纤内的光源，从而当导管插入患者体内时所导入的光经由光纤到达导管末端，并且从所插入的导管的末端发出的光经过患者组织到达患者体外，不侵入患者体内的检测装置，检测从患者体外发出的光以帮助操作人员确定导管末端在患者体内的位置。
附图说明
以下参照附图进一步详细说明本发明的光导系统和用于插入气管内导管、鼻饲管、饲管、硬膜导管、中央静脉导管、外插式中央静脉导管、胸腔管多级导管、和类似的侵入性导管和管子的方法，其中：
图1表示具有用在本发明中定位所插入导管的末端的集成光纤的导管的横截面。
图2表示图1的导管的侧视图。
图3表示插入到患者体内的图1的导管以及根据本发明的方法在最靠近患者皮肤的位置检测来自导管末端的光。
具体实施方式
本发明的光导系统包括一个激光二极管，它具有620nm到1100nm范围内的波长，优选地780nm的波长，其发射宽度小于2nm并且功率小于5mw，它通过一个150微米(或更小)的玻璃芯光纤在末端承载在“ST”光学连接器上。如图1所示，玻璃光纤10嵌在具有导管管腔40的导管30的壁20内(即部分地或者全部地由壁20包围)。光纤10经过导管30的整个长度，并且如图2所示位于导管30的末端50的光纤10的无终端接头的端部可以插入到患者体内。近端60终止于ST光学连接器(未示出)，该ST光学连接器用于将光纤10连接于激光二极管(未示出)。相反地，光纤10可以在其近端60插入导管30的管腔40并且提供到导管30的末端50并固定在位从而导管30插入到患者体内之后光从末端50逸出。
操作人员使用诸如近红外夜视镜70从所选位置的入口处观察导管30的推进。导管30末端50被看作是单一光源并且检测来自该光源的散射光线。利用具有780nm的中心波长的窄带干涉滤波器80(优选地在半高处小于10nm，但是也可以使用较宽带通的滤波器)覆盖镜70的检测器表面。通常，随着光学滤波器带通宽度的增加其他环境光的影响增大。选择小于10nm的值以允许激光二极管波长中的一些变化并且还使得经过镜70的检测器的并非来自激光二极管的光量最少。当然，如果使用其他波长的光，那么可以使用以其他波长为中心的合适的干涉滤波器。
图3表示经由鼻饲管30插入到患者体内的图1和2的导管30以及根据本发明的方法在最靠近患者皮肤的位置检测来自导管30的末端50的光。在如图3所示的例子中，其上具有合适的干涉滤波器80的夜视镜70允许操作人员通过患者胃部外的皮肤看到红外光。
本领域技术人员将可以明白利用不同的光源和光检测器可以构造本发明的用于导管的光导系统。尽管780nm的光是适宜的因为在该波长处组织吸收接近最小，但是例如可能采用LED作为光源，只要所提供的光具有合适的波长和能量。在这种情况下，检测器上需要较宽带通的滤波器(LED光输出宽于激光二极管的光输出)。类似地，可以使用不同的检测器，包括光电二极管、光电倍增器、雪崩光电二极管以及微道通板。当使用光电二极管或者其他单点检测器时，它们可以移动到组织表面上来检测从光纤发出的特定光的最大值。可以通过以特定频率(例如1000Hz)调制光并且仅仅检测该频率下的光电信号来最大化测量的灵敏度。
可以允许操作人员检测导管具有不适当的“双折(doubled back)”的情况的另一种变化将包含两个光纤，一个终止于末端之前大约5厘米而另一个位于末端。这两个可以由光的调制频率和/或波长来区别。
在检测系统的一种变化中，夜视镜70包括在操作人员一只眼前面的小型显示屏中的灵敏的微道通板成像器。这将允许操作人员根据需要观察患者或者显示屏。
尽管以上详细说明了本发明的实施例，但是本领域技术人员容易明白，可以对实施例做出其他修改而不脱离本发明的新颖内容和优点。任何这些修改都将包含在由所附权利要求书限定的本发明的范围内。

Claims (9)

1.一种用于在患者体内定位侵入性导管的光导系统，包括：
导管；
插入所述导管内从而延伸到所述导管的末端的光纤；以及
在导管近端将光导入所述光纤内的光源，从而当导管插入患者体内时所导入的光经由光纤到达导管末端，并且从所插入的导管的末端发出的光经过患者组织到达患者体外，
不侵入患者体内的检测装置，检测从患者体外发出的光以帮助操作人员确定导管末端在患者体内的位置。
2.如权利要求1所述的光导系统，其特征在于，光源包括以620nm到1100nm的波长范围发出光的LED和激光二极管之一。
3.如权利要求2所述的光导系统，其特征在于，光源以780nm的波长发出光。
4.如权利要求1所述的光导系统，其特征在于，所述检测装置包括夜视镜，在其检测表面上具有干涉滤波器，干涉滤波器有效地阻挡包括由所述光源发出的波长范围在内的窄带之外的波长范围内的光。
5.如权利要求4所述的光导系统，其特征在于，所述夜视镜包括在操作人员一只眼前面的小型显示屏中的微道通板成像器。
6.如权利要求1所述的光导系统，其特征在于，所述检测装置包括光电二极管、光电倍增器、以及微道通板中的至少一个。
7.如权利要求1所述的光导系统，其特征在于，光纤嵌在导管壁内。
8.如权利要求1所述的光导系统，其特征在于，光纤插入导管的管腔内从而延伸到导管末端并且在导管插入到患者体内期间光纤固定在位。
9.如权利要求1所述的光导系统，其特征在于，还包括插入到所述导管内并终止于离所述光纤的终止位置预定距离的终止位置并且传输光的第二光纤，该第二光纤传输的光具有(1)与所述光纤传输的光不同的调制频率以及(2)与所述光纤传输的光不同的波长中的至少一个，从而可以通过从各个光纤发出经过患者组织到达患者体外的光的位置确定插入期间所述导管的双折。
CNB028124065A 2001-06-19 2002-06-19 用于侵入性导管定位的光导系统 Expired - Fee Related CN100446723C (zh)

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CA2451669A1 (en) 2002-12-27
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