Search

CN-119791845-B - Treatment equipment for reducing positive incisional margin after radical prostatectomy

CN119791845BCN 119791845 BCN119791845 BCN 119791845BCN-119791845-B

Abstract

The invention discloses a treatment device for reducing positive incisal margin after radical prostatectomy, which comprises an injection device for injecting a PSMA probe into a body, a PET/CT imaging device, a near infrared fluorescence imaging device and a surgical robot, wherein the near infrared fluorescence imaging device displays the fluorescence level of tumor tissues and normal tissues of the prostate of a patient injected with the probe, and performs fluorescence imaging on the tumor tissues of the prostate according to the fluorescence intensity of the probe in urine. The treatment equipment disclosed by the invention can be used for carrying out fluorescent imaging on tumor tissues in the resection and accurately positioning, an operation robot can accurately resect the tumor tissues under fluorescent navigation, the positive rate of the incisional edge after the operation is obviously reduced, the biochemical recurrence risk of a patient is obviously reduced and the prognosis is good after the radical prostatectomy is carried out by adopting the treatment equipment disclosed by the invention, and complications such as erectile dysfunction, urinary incontinence, urethral stricture and the like caused by damage to nerve vascular bundles in the operation can be avoided, so that the influence on the life quality of the patient after the operation is obviously reduced.

Inventors

  • LI XUESONG
  • CHEN CHENG
  • YANG XING
  • ZHANG JIANHUA
  • CHEN SILU
  • XU HONGCHUANG
  • CHEN XUEQI

Assignees

  • 北京大学第一医院(北京大学第一临床医学院)

Dates

Publication Date
20260508
Application Date
20250103

Claims (12)

  1. 1. A therapeutic apparatus for reducing positive cut-off after radical prostatectomy comprising: an injection device for injecting a PSMA-targeting nuclide/fluorescent bimodal molecular probe, i.e., PSMA probe, into a patient; A PET/CT imaging device for displaying the position of prostate tumor of a patient injected with a PSMA probe; an intraoperative near infrared fluorescence imaging device for displaying tumor tissue and normal tissue fluorescence level of prostate of a patient injected with a PSMA probe; The surgical robot is used for completely cutting off the prostate and tumor tissues of the patient according to the position of the prostate tumor of the patient displayed by the PET/CT imaging device and the position of the tissue positively displayed by the intraoperative near infrared fluorescent imaging device; Wherein, the near infrared fluorescence imaging device performs fluorescence imaging on the tumor tissue of the prostate of the patient according to the fluorescence intensity of the PAMA probe in the urine of the patient, namely, performs fluorescence positive imaging on the tumor tissue of the prostate of the patient after the fluorescence intensity of the PAMA probe in the urine of the patient is attenuated by more than or equal to 90 percent, namely, performs fluorescence brightening on the tumor tissue of the prostate of the patient; Wherein the PSMA probe is a PSMA targeting nuclide/fluorescent bimodal ligand shown in a radionuclide marked structural formula (2), (2) Wherein n=1, 2, 3, 4 in formula (2).
  2. 2. The therapeutic apparatus of claim 1, wherein n = 3 in formula (2).
  3. 3. The therapeutic apparatus according to claim 1 or 2, wherein the near infrared fluorescence imaging device detects the fluorescence intensity of the PAMA probe in the urine of the patient and calculates the attenuation amount of the fluorescence intensity of the PAMA probe in the urine of the patient.
  4. 4. A therapeutic device according to claim 3, wherein the radionuclide is one of 68 Ga、 64 Cu、 18 F、 86 Y、 90 Y、 89 Zr、 111 In、 99m Tc、 11 C、 123 I、 125 I or 124 I.
  5. 5. The therapeutic apparatus of claim 4, wherein the radionuclide is 68 Ga.
  6. 6. The therapeutic apparatus of claim 5, wherein the amount of radionuclide in the PSMA probe is (0.05-0.1) mCi/kg.
  7. 7. The therapeutic apparatus of claim 6, wherein the amount of radionuclide in the PSMA probe is 0.1mCi/kg.
  8. 8. The therapeutic apparatus of claim 1 or 2, wherein the PSMA probe is injected into the patient using an injection device at an injection dose of (0.004-0.04) mg/kg.
  9. 9. The therapeutic apparatus of claim 8, wherein the PSMA probe is injected into the patient using an injection device at an injection dose of 0.04 mg/kg.
  10. 10. The therapeutic apparatus of claim 1 or 2, wherein the near infrared fluorescence imaging device is selected from a Firefly imaging system of a Davinci surgical robot, a fluorescence imaging module of a fluorescence laparoscope.
  11. 11. The treatment apparatus according to claim 1 or 2, wherein the surgical robot for resecting tumor tissue of the prostate of the patient is a laparoscopic surgical robot.
  12. 12. The treatment apparatus of claim 11, wherein the surgical robot that resects tumor tissue of a patient's prostate is a da vinci surgical robot or a conduo surgical robot.

Description

Treatment equipment for reducing positive incisional margin after radical prostatectomy Technical Field The invention relates to a treatment device for prostatectomy, in particular to a treatment device for reducing positive cutting edge after radical prostatectomy, belonging to the field of medical devices. Background In recent years, a surgical robot system has a high-definition amplified three-dimensional stereoscopic vision and a flexible mechanical arm with more degrees of freedom, so that a robot radical prostatectomy (RARP) is becoming a mainstream mode for treating prostate cancer in a surgical way at present. The RARP can remarkably improve the operation precision, has remarkable advantages in aspects of short-term urinary control, sexual function, short-term complications and the like, and can realize the oncology outcome similar to the traditional open operation. The key to the success of RARP is to completely resect tumor tissue while maximally preserving the surrounding important functional structures. In order to achieve these two objectives simultaneously, it is important to accurately identify tumor boundaries during surgery. The rapid development of prostate cancer specific imaging technology greatly improves the accuracy of prostate cancer diagnosis and staging. However, the operator still relies on the experience of the operator, and combines limited visual information such as color, texture and morphology and tactile information such as hardness or surface smoothness to identify the prostate cancer tissue and non-cancer tissue, and the subjective judgment mode has a high positive (positive surgical margin, PSM) rate of surgical margin, the positive rate of the surgical margin of the current RP is as high as 6-50%, and the PSM can increase the risk of biochemical recurrence after the operation of the patient, so that the prognosis of the patient is affected. In recent years, navigation technology in near infrared fluorescence opens up a new approach for accurate treatment of prostate cancer. In the RARP operation, manny and the like inject fluorescent imaging agent indocyanine green (indocyanine green, ICG) into the prostate of a patient, successfully marks the prostate tissue and the sentinel lymphatic network, effectively distinguishes structures such as the prostate and peripheral nerve vascular bundles, vas deferens and the like, effectively distinguishes lymph nodes from adjacent nerves and blood vessels, obviously reduces the risk of accidentally injuring peripheral blood vessels and nerves in the operation, however, the non-tumor specificity of ICG cannot specifically distinguish lymph nodes with tumor metastasis from normal lymph nodes and cannot distinguish tumor tissues and normal tissues of the prostate, and therefore, high-specificity targets are required to perform accurate imaging so as to realize more accurate navigation in the operation. It was found that prostate specific membrane antigen (prostate specific membrane antigen, PSMA) was specifically overexpressed (100-1000 fold) on the surface of 90% of prostate cancer cells, the level of expression being closely related to tumor invasion and malignancy stage. The target is used for the nuclide imaging and radioligand treatment of the prostate cancer, and is an ideal biomarker for the accurate positioning imaging of the prostate cancer lesion. The PSMA-targeting fluorescent probe generally consists of three parts, a PSMA targeting group, a spacer group, and a fluorophore. Wherein the targeting group is usually a small molecule inhibitor targeting PSMA, ensuring efficient affinity with PSMA protein. The fluorescent group is usually near infrared fluorescent dye such as indocyanine green, IRDye800RS, IRDye800CW, cy7, cy5.5 and corresponding derivatives. And combining the near infrared dye with the PSMA targeting group to synthesize a series of PSMA targeting fluorescent probes, thereby realizing real-time fluorescent imaging of the PSMA positive focus in the operation. The fluorescent probe targeting PSMA has high affinity with PSMA protein, and can realize specific fluorescent imaging in tumor. The existing targeted PSMA probe is divided into a single-mode near-infrared fluorescent probe and a nuclide/fluorescent bimodal molecular image probe, the single-mode near-infrared fluorescent probe is limited by the penetration depth of the single-mode near-infrared fluorescent probe and is difficult to identify a deeper tumor focus, for a patient planned to receive navigation in the PSMA targeted near-infrared fluorescent probe operation, the fluorescent probe needs to be injected for operation navigation after the nuclide imaging probe is cleared after the PSMA PET/CT for a period of time, the treatment opportunity of the patient is influenced, the dual-mode molecular image probe overcomes the defect of a single imaging technology by integrating infrared fluorescent dye and radioisotope in a single ligand, the dual-mode functional