CN1179727A - 用光能刺激生物组织的方法 - Google Patents

用光能刺激生物组织的方法 Download PDF

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CN1179727A
CN1179727A CN95197798A CN95197798A CN1179727A CN 1179727 A CN1179727 A CN 1179727A CN 95197798 A CN95197798 A CN 95197798A CN 95197798 A CN95197798 A CN 95197798A CN 1179727 A CN1179727 A CN 1179727A
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G·J·比林格
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LASER BIOTHERAPY CO
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    • A01M—CATCHING, TRAPPING OR SCARING OF ANIMALS; APPARATUS FOR THE DESTRUCTION OF NOXIOUS ANIMALS OR NOXIOUS PLANTS
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    • A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
    • A01M—CATCHING, TRAPPING OR SCARING OF ANIMALS; APPARATUS FOR THE DESTRUCTION OF NOXIOUS ANIMALS OR NOXIOUS PLANTS
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    • A01M1/02—Stationary means for catching or killing insects with devices or substances, e.g. food, pheronones attracting the insects
    • A01M1/04—Attracting insects by using illumination or colours
    • A—HUMAN NECESSITIES
    • A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
    • A01M—CATCHING, TRAPPING OR SCARING OF ANIMALS; APPARATUS FOR THE DESTRUCTION OF NOXIOUS ANIMALS OR NOXIOUS PLANTS
    • A01M1/00—Stationary means for catching or killing insects
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    • A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B2017/00141—Details of operation mode continuous, e.g. wave
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    • 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
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    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
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    • A61N5/067—Radiation therapy using light using laser light
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Abstract

以一定的波长和功率耗散水平用光能照射活体生物组织,使得在组织中被吸收的和被转化成热的光能的量在由足以使被辐射组织的平均温度提高到活体基础体温水平之上的最小吸收率,但低于组织转化成胶原物质时的吸收率所限定的范围内。根据这一方法,在被照射的组织中产生治疗和温暖效果,但不引起由加热过度产生的组织损伤。业已发现,使用100毫瓦到800毫瓦的低水平反应性激光系统,以脉冲或连续方式在1,064纳米基本波长下由Nd:YAG激光产生光能的方法可降低软组织疼痛、减少发炎和经刺激微循环促进组织愈合,而不使活组织受到损伤性的热作用。

Description

用光能刺激生物组织的方法
本发明的背景
1.发明领域
本发明总的来说涉及经光辐射治疗活生物组织的方法，具体地说，本发明涉及用激光辐射刺激软的活组织的方法。
2.背景技术描述
各种非手术方法已用于活组织的治疗处理。这种技术包括使用超声波能、电刺激、以透热疗法、X射线和微波照射进行的高频刺激。电刺激、透热疗法、X光和微波照射之类的技术对软组织已显示出某些治疗优点。然而，由于过度的热作用造成的组织损伤，它们的使用受到某种程度的限制。因而，用涉及透热疗法、X射线，微波和电刺激的治疗处理有关的能量水平已被限制在如此低的水平上以致于只能获得很少的益处或者根本不能获得益处。此外，必须细心地控制微波和X-射线辐射的剂量或暴露以避免出现与所述的辐射相关的健康问题。超声波能不被优先吸收并且影响所有周围的组织。
由激光产生的光能已被应用于各种医学和外科目的，由于激光光线的单色与连续的性质，依据所照射的组织的性质和光线的波长的某些特征(包括反射率、吸收系数、散射系数、热传导率以及热扩散常数)，其可以被活组织选择性地吸收。反射率、吸收系数和散射系数取决于光辐射的波长。已知吸收系数依赖于带内(interband)跃迁、自由电子吸收、栅格吸收(声子吸收)和杂质吸收之类的因素(其取决于光辐射的波长)。
在活组织中，水是一个在红外范围中有吸收带(按照水分子的振动)的主要的组分。由于血红蛋白的存在，在可见范围中存在吸收。而且，在活组织中的散射系数是一个占主要地位的因素。
这样，对于一种给定的组织类型而言，激光光线可以通过组织传播，基本上不衰减，或者几乎可以被彻底地吸收。组织被加热并最终被破坏的程度取决于它吸收光能的程度。一般来说，激光光线最好是在希望不受影响的组织中基本上被传送，在待受影响的组织中被吸收。例如，当在由血液或水润湿的组织处使用激光辐射时，希望光能不被水或血液吸收，从而使激光能特异性地针对待治疗的组织。激光治疗的另一个优点是光能可以以精确的、非常有限的位置和以预定的有限的能量水平被传送到治疗组织。
已知红宝石和氩激光发射电磁光谱可见部分的光能，并且已成功地用于眼科学领域，以便将视网膜再连接到下面的脉络膜上，和经穿过眼睛前面的部分减少眼间压力来治疗青光眼。红宝石激光能具有694纳米的波长，在可见光谱的红色部分。氩激光发射在488和515纳米的能量，因此出现在可见光谱的蓝绿色部分。红宝石和氩激光光束很少地被水吸收，但被血液色原体血红蛋白强烈吸收。这样，红宝石和氩激光能很少被非着色的组织(如眼角膜，透镜以及玻璃体)吸收，但是较好地被着色的视网膜吸收，其然后在此发生热作用。
已在外科手术中采用的另一种激光类型是二氧化碳(CO2)气体激光，其发射强烈地被水吸收的光束。CO2激光的波长为10.6微米，因此位于电磁光谱的不可见远红外区，并且不依赖于组织颜色被所有具有高水含量的软组织吸收。这样，CO2激光构成了一个良好的外科解剖刀和汽化器。因为它完全被吸收，所以其穿透的深度浅，就所治疗的组织表面而言可被精确地控制。因此，CO2激光非常适合用于各种外科方法中，其中其对蒸发或者凝结无色组织是必需的，对邻近组织具有的最小的热破坏。
另一个得到广泛利用的激光是钕涂布的钇-铝-石榴石(Nd：YAG)激光。Nd：YAG激光在电磁光谱的近红外区中其1,320纳米第二波长处具有作用的良好方式。Nd：YAG光发射被血液吸收的程度高于被水吸收的程度，这使得其在凝结大的出血脉管上有用。在1,320纳米的Nd：YAG激光已通过内窥镜发射来治疗各种胃肠流血损伤，如食管的脉管曲张、消化器官溃疡以及动静脉异常。这样的激光能的应用非常适合于需要高能热作用的场合(如组织汽化、组织烧灼、凝结)和作为外科手术刀。
下列美国专利公开了通过激光辐射治疗处理活组织的仪器和方法：
         3,456,651     3,720,213     4,141,362
    4,144,888    4,367,729       4,561,440
    4,573,465    4,589,404       4,601,288
    4,604,992    4,672,969       4,692,924
    4,705,036    4,931,053       4,966,144
三个专利：Dew，4,672,969.00；L Esperance，Jr.4,931,053.00(1990年6月5日申请)；和Rochkind等4,966,144.00(1990年10月30日申请)充分描述了现有技术，这一现有技术教导了在某些特定的应用中使用激光能。Dew公开了一种激光(具体地说是在1,320纳米的第二波长下进行操作的Nd：YAG激光)的用途。Dew公开了Nd：YAG激光通常在1,060纳米进行操作。Dew专利的目的是使用激光使得创伤闭合和重构生物组织。激光能转化成热，热最终将组织断裂成充当″生物粘合剂″的胶原成份。
L Esperance教导了用于可见红或低红外与极端低能激光照射组织中的两种激光光束的利用。L Esperanc教导了使用氦-氖或者氪激光。L Esperance所使用的波长是传送15毫瓦输出功率的610-660纳米。
Rochkind(1990年10月30日申请)使用连续的或不连续的寿命(life)，但描述了在632纳米(具有16毫瓦/cm2强度)进行操作的氦-氖激光或者产生465或520纳米(具有约40毫瓦/cm2光强度)的氩型激光。此外，Rochkind描述了实现发明所寻求的方法的两步法；在外科手术期间打开和暴露组织时进行第一次处理，在缝合后进行第二次处理。
发明目的
已在非常低功率(典型地完全在100毫瓦以下)水平上尝试了用于刺激软组织以减少疼痛和发炎，刺激微循环以减少愈合时间之目的的常规激光的使用。尽管已取得某些治疗益处，但治疗时间长得不可接受。
因此，本发明的目的是提供为了治疗目的安全有效地将反应性激光施用于活组织而不需将所说组织暴露在破坏性的热作用下的方法，所述的治疗目的例如以较高水平的功率减少疼痛、减少发炎，和通过刺激微循环促进组织愈合。这一方法缩短了本领域已知的治疗时间。发明概述
已发现本发明的方法在不将所说活组织暴露在破坏性的热作用下减少软组织疼痛、减少发炎和通过刺激微循环促进组织愈合，所述方法使用100毫瓦到800毫瓦范围内低水平反应性激光系统，用Nd：YAG激光在1,064纳米的基础波长下产生的光能以脉冲或连续方式进行。在另一种方法中，光能是由1,055纳米波长的钕涂布的钇-锂-氟化物(Nd：YLF)激光产生的，或者由在1,000至1,150纳米优选波长范围内的某些其它激光产生的。在波长和功率组织耗散水平上用光能照射活组织，以便产生被吸收和被转化成热的光能的量在足以将所照射的组织的平均温度提高到基础体温之上的最小吸收率所限定的范围内，但低于组织转化成胶原物质时的吸收率。小心控制波长、位点、光束大小、功率、暴露时间，以便在所照射的组织中产生明显的热作用，但该作用是有限的以避免热作用产生的组织损伤。
没有所引用的现有技术教导了本发明。如本说明书所提出的，Nd：YAG激光在其1,064纳米的基本波长(具有80-100毫瓦的功率)下进行操作。或者Nd：YLF激光在1,055纳米的波长(具有相同的功率范围)下进行操作。L Esperance和Rochkind都没有教导以这种特定的方式使用Nd：YAG激光。L Esperance和Rochkind都详细描述了约本发明的一半波长的优选的操作方法。事实上，L Esperance利用了两个光束而非一个光束。没有现有技术公开Nd：YAG激光在其1,064纳米基本波长处的用途。
下表比较了Dew、L-Esperance和Rochkind的技术与本发明。
专利 激光类型 波长(NM) 功率(MW) 用途
Dew Nd：YAG 1,320 1000-5000 Scapel
L′Esperance He-Ne 633 15 治疗
Rochkind He-NeAr 632520 1680 治疗
Bellinger Nd：YAG 1,064 100-800 治疗
尽管L′Esperance可以教导Rochkind的方法，但甚至没有现有技术暗示Nd：YAG激光可以以这种方式用很大的功率使用和获得所需的结果。
优选实施方案的描述
按照优选的方法，所述激光能是以100-800毫瓦输出功率水平和1.064纳米基本波长由Nd：YAG激光产生的。将所述激光光能运用于身体的需要减少肌肉痉挛、增加循环、减少疼痛或者加快组织愈合的区域。界定表面区域，以所需量的时间和强度(具有限制在约1焦耳/cm2到约15焦耳/cm2范围的被照射组织能量密度)用激光光束照射组织表面以产生所需的治疗作用。治疗的强度和时间长短由待治疗的组织、所需侵入的深度、损伤的剧烈程度以及患者的状况确定。
为了减少疼痛、减少发炎、并经刺激微循环加快组织愈合的目的，说明了一个低水平反应性激光系统的治疗处理方法，所有过程在不产生组织破坏性热作用的情况下成功地进行。一个Nd：YAG激光共振器用作激光源。其基本波长是1,061纳米，并且具有100毫瓦-800毫瓦的可调光束能量输出。所述激光可以以脉冲或者连续方式进行操作，其输出由在0.1-9.9分钟范围内的暴露定时器控制。脉冲接通时间以0.1秒间隔时间在0.1-9.9秒的范围内可调。脉冲断开时间也以0.1秒间隔时间在0.1-9.9秒的范围内可调。Nd：YAG激光光束在1,064纳米的电磁光谱红外部分(因此是不可见的)进行操作。将光束传送到靶范围内的方法是采用柔软的石英纤维与聚焦的机头。
Nd：YAG激光光束脱离激光头的输出耦合器，并在通过循环可变的中等密度衰减器之前由一对排列的楔形物引导。穿过衰减器的光线通过一对在光学纤维电缆最接近的末端上的90毫米焦点长透镜聚焦。
主要光束衰减器是放置在输出耦合器和光束引导镜之间的激光头外部的开闭器。其包括四个组件：90度反射棱柱、开闭器臂，开闭器安装支架和促进螺线管。棱柱安装到开闭器臂上，以便在通常关闭的位置上棱柱拦截激光光束，并将其向下反射到激光板中的光束堆存处(dump)。当输出通道被选择，并且脚踏板被压下时(其导致开闭器臂提高并使得光束提高)，螺线管是有能量的。当螺线管臂去能量时，开闭器下降到关闭的位置。
光能由一种连续的光源产生，优选的是由在电磁光谱的近红外区中的1,064纳米波长的激光产生。激光由指导光能光束到组织表面的光纤维导向装置和耦合器提供。控制光辐射的能量，并用于产生在所照射的组织中的最小吸收率，该吸收率将所照射组织的平均温度提高到基础体温水平之上，但其不超过最大吸收率(其大得足以将所照射的组织转化成胶原物质)。
通过广泛的试验已确定，在100-800毫瓦功率输出的水平的1,064纳米的主要波长下，以在治疗位点上产生约1.0焦耳/cm2和15焦耳/cm2范围内的发射激光光束能量密度的聚焦的激光光束操作Nd：YAG激光时可满足上述条件。
当使用上述方法时，观察到了在组织中的和在细胞水平上的某些生理机制。在微循环系统评价中，例如，血液脉管壁具有感光性已被证明。当血液脉管壁暴露于以上提出的激光辐射时，紧张在平滑肌细胞中受到抑制，这样，在毛细管中增加血流量。已观察到的其它作用是：外周的毛细新血管形成、血液血小板聚集减弱、三价至单价形式的O2还原(由此使得组织有更大的氧合作用)、在血液中缓冲物质浓度降低、红细胞变形指数稳定、血液过氧化的脂氧化产物减少。已观察到的其它作用是抗凝血酶活性指数增加、抗氧化剂系统酶(如超氧化物歧化酶和过氧化氢酶)的刺激作用。观察到从所照射的区域的静脉和淋巴和流出物增加。在上述区域中的组织渗透性实质上得到提高。这有助于在组织中立刻减少水肿和血肿浓缩物。在细胞水平上，也注意到线粒体产生增加量的ADP，尔后增加ATP产生。也似乎增加了组织膜上在细胞水平上的钙和钠泵的刺激作用。
在神经元水平上，观察到了作为前述治疗处理的结果的下列作用。首先，存在压碎的和完整的神经的增加的作用潜力。在所照射的区域上血液供给和轴突数量增加。当组织被治疗时，注意到伤疤组织的抑制作用。存在神经膜通透性的立即增加。已观察到通过神经的钙和钾离子通透性至少在120天长期变化。RNA和随后的DNA的生产增加。产生单价氧(其在细胞再生中是一个重要的因素)。具有神经损伤的病理退化改变成再生。星形胶质细胞和少突神经胶质细胞受到刺激，造成外围神经轴突和髓磷脂的生产增加。
血液的吞噬细胞裂解增加，进而实质上减少感染。也显示出明显的抗炎症现象，其使得腱、神经、关节囊的炎症减少，同时产生加强的胶原。在有限的循环条件下在伤口闭合中也有对明显增加的粒状组织的影响。
已观察到组织的痛觉缺失与组织水平上的复杂的系列活动相联系。在局部水平上，有炎症的减弱，引起渗出物的再吸收。脑啡肽和内啡肽得到补充，在脊髓水平上和人脑中调节疼痛的产生。serotnogenic途径也得到补充。虽然不是完全清楚，但人们相信组织的照射造成在细胞水平上的能量平衡的回复(这是疼痛减弱的原因)。
在另一种方法中，激光能是由1,055纳米的波长的Nd：YAG激光产生的。其它激光可被使用或者被开发，以便以相同的功率水平在约1,000到约1,150纳米的优选的范围内进行操作。
尽管参照优选的方法和参照特定的治疗用途描述了本发明，但以上的描述不是用来进行限制性意义上的解释的。对本领域技术人员而言，以上说明书的内容提示了所公开的实施方案的修改和本发明的其它应用。因此，应注意到，所附权利要求将覆盖落于本发明真正范围内的任何这样的修改或实施方案。

Claims (20)

1.一种用于治疗活体生物组织小治疗区而不需将所说组织暴露在损伤性热作用下的方法，所说的方法包括：
用一种低水平反应性激光产生连续的光能辐射，该辐射具有在电磁光谱近红外区范围内的波长，其输出功率在约100毫瓦到约800毫瓦的范围内，和
将所说的连续的光能辐射聚焦在所说的小治疗区，以使在所照射的组织中吸收和转化成热的比率在足以使被辐射组织的平均温度提高到活体基础体温水平之上的最小比率与低于所照射的组织转化成胶原物质时的比率的最大比率之间的范围内，其中所说的光能辐射在所照射的组织位点上的密度在约1.0焦耳/cm2到约15焦耳/cm2的范围内。
2.按照权利要求1的方法，其中所说的波长是约1,064纳米。
3.按照权利要求2的方法，其中所说的低水平反应性激光包括Nd：YAG激光。
4.按照权利要求3的方法，其中在栅格中的许多小治疗区上用所说的连续的光能辐射以提供治疗效果所需量的时间和强度照射所说的组织。
5.按照权利要求3的方法，其中每一个小治疗区具有在约0.5mm2到约2mm2的范围内的区域。
6.按照权利要求3的方法，其中所说的低水平反应性激光用接通时间在0.1至9.9秒范围内，断开时间在0.1至9.9秒范围内的各脉冲来脉冲。
7.按照权利要求3的方法，其中以继续不断的方式操作所说的低水平反应性激光。
8.按照权利要求1的方法，其中所说的波长是约1,055纳米。
9.按照权利要求4的方法，其中所说的低水平反应性激光包括Nd：YLF激光。
10.按照权利要求9的方法，其中在栅格中的许多小治疗区上用所说的连续的光能辐射以提供治疗效果所需量的时间和强度照射所说的组织。
11.按照权利要求9的方法，其中每一个小治疗区具有在约0.5mm2到约2mm2的范围内的区域。
12.按照权利要求9的方法，其中所说的低水平反应性激光用接通时间在0.1至9.9秒范围内，断开时间在0.1至9.9秒范围内的各脉冲来脉冲。
13.按照权利要求9的方法，其中以继续不断的方式操作所说的低水平反应性激光。
14.按照权利要求1的方法，其中所说的低水平反应性激光包括Nd：YAG激光。
15.按照权利要求1的方法，其中所说的低水平反应性激光包括Nd：YLF激光。
16.按照权利要求1的方法，其中在栅格中的许多小治疗区上用所说的连续的光能辐射以提供治疗效果所需量的时间和强度照射所说的组织。
17.按照权利要求1的方法，其中每一个治疗点具有在约0.5mm2到约2mm2的范围内的区域。
18.按照权利要求1的方法，其中所说的低水平反应性激光用接通时间在0.1至9.9秒范围内，断开时间在0.1至9.9秒范围内的各脉冲来脉冲。
19.按照权利要求1的方法，其中以继续不断的方式操作所说的低水平反应性激光。
20.按照权利要求1的方法，其中所说的波长在约1,000纳米到约1,150纳米的范围内。
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HUT77599A (hu) 1998-06-29
US5445146A (en) 1995-08-29
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