CO2激光和Nd∶YAG激光吻合家犬肝切创的实验研究
作者：徐遵迪 李峻亨 李维华
单位：徐遵迪(济南军区总医院250031)；李峻亨 李维华(解放军总医院)
关键词：激光；肝破裂
中国激光医学杂志990107摘要
目的 探讨CO2激光和Nd∶YAG激光吻合肝切创的可行性，为临床应用激光吻合肝破裂提供实验依据。
方法 普通家犬5只，静脉麻醉后剖腹，暴露肝脏，在其表面做两条长2～5 cm、深4～10 mm切口。分别用CO2激光和Nd∶YAG激光照射创口，CO2激光的输出功率为3 W，照射距离0.5～2.0 cm，光斑直径0.2 cm，垂直照射20～90 s，能量密度1 910～8 595 J/cm2；Nd∶YAG激光光纤末端功率为5 W，照射距离0.3～0.5 cm，光斑直径0.4 cm，垂直照射20～90 s，能量密度为800～3 600 J/cm2。术后即刻、1、3、12和28天各处死1只家犬，取切口处肝组织，做病理检查，观察切口愈合情况。
, http://www.100md.com
结果 肉眼观察，照射即刻创口的出血迅速停止，创口紧闭，CO2激光吻合后的创口宽2～3 mm，表面光滑，Nd∶YAG激光吻合后的创口宽4 mm，表面有炭化屑；术后12天及28天，创口表面光滑，愈合良好。镜下观察，照射后即刻的吻合口表面至深层有3个组织层次，表面为炭化组织，中间为凝固组织，深层为出血充血组织；28天时创口已纤维化，炭化组织已吸收。
结论 CO2激光和Nd∶YAG激光均可以有效地吻合肝切创，CO2激光对周围组织的损伤较小，而Nd∶YAG激光对渗血创口的吻合较CO2激光更为有效。
CO2 Laser and Nd∶YAG Laser Irradiation for Liver Incision Closure in Dogs
XU Zundi1, LI Junheng2, LI Weihua2
, 百拇医药
1.General Hospital of Jinan Command, Jinan 250031 2.Chinese PLA General Hospital,Beijing
ABSTRACT
Objective The feasibility of CO2 laser and Nd∶YAG laser closure in sealing of dog liver incisions was studied.
Methods Five healthy adult dogs of either sex were anesthetized with intravenously administered sodium thiopental(50 mg/kg). Using sterile operative technique the livers were exposed and two incisions were made with scalpel on its surface. The incisions length was 2-5 cm and depth was 4-10 mm. CO2 laser: The power output was 3 W, vertical irradiation distance was 0.5-2.0 cm, spot diameter was 0.2 cm, irradiation time was 20-90 s, energy density was 1 910-8 595 J/cm2. Nd∶YAG laser：Power at the fiber tip was 5 W, vertical irradiation distance was 0.3-0.5 cm, spot diameter was 0.4 cm, irradiation time was 20-90 s, energy density was 800-3 600 J/cm2. The animals were killed at 0,1,3,12 and 28 days after sealing, respectively, and histological changes were examined by routine light microscopy.
, http://www.100md.com
Results Macroscopic findings: No blood leaks were noted from all the sealed incisions. Immediately after sealing, the CO2 laser lesions appeared as a 2-3 mm zone, while the Nd∶YAG laser lesions showed a narrow band (about 4 mm) of coagulated and necrotized tissue. Both the CO2 laser and Nd∶YAG laser closures were firm and tight. There were no breaks in all lesions and the livers were put back into the abdominal cavity. At 12 and 28 days after operation, the incision cut were healed excellently. Microscopic findings: Immediately after sealing, there were three layers of changes from surface to depths: canbonization, coagulation and congestion. Fibrous tissues were found in incision after 28 days. The irradiation damage caused by Nd∶YAG laser adjacent to the closure was more evident than that of CO2 laser.
, 百拇医药
Conclusions This preliminary experiment showed that both CO2 laser and Nd∶YAG laser may be used to seal the ruputure of liver. The damage caused by CO2 laser closure is milder than that of Nd∶YAG laser. However, Nd∶YAG laser is more useful to melt bleeding tissues and may be more effective for larger hepatorrhexis.
Key words Lasers; Hepatorrhexis
临床治疗工作中将激光作为一种切割、烧灼组织的手段，已有大量报道[1-3]，近年来又陆续有低功率激光吻合血管、神经、皮肤等的研究报道[4-6]。为探讨激光吻合肝破裂的可行性，我们进行了CO2激光和Nd∶YAG激光吻合肝切创的实验研究。
, http://www.100md.com
材料和方法
普通家犬5只(由解放军总医院动物实验室提供)，体重10～15 kg，硫贲妥钠50 mg/kg静脉麻醉，剖腹暴露肝脏，于肝脏表面做两条长2～5 cm、深4～10 mm的切口，随机分别采用CO2激光和Nd∶YAG激光进行吻合。CO2激光的输出功率为3 W，照射距离0.5～2.0 cm，光斑直径0.2 cm，垂直照射20～90 s，能量密度1 910～8 595 J/cm2；Nd∶YAG激光光纤末端功率为5 W，照射距离0.3～0.5 cm，光斑直径0.4 cm，垂直照射20～90 s，能量密度为800～3 600 J/cm2。两种激光不重叠照射。术后即刻、1、3、12和28天各处死1只家犬，取切口处肝组织，切片，苏木精-伊红染色，做病理学检查。未即刻处死的家犬只做手术切口简要包扎及一般护理，无特殊处理。
结果
, http://www.100md.com
肉眼所见：照射即刻创口的出血迅速停止，创口闭紧，Nd∶YAG激光的止血效果较CO2激光好，更适合渗血较多的创口。CO2激光吻合后的创口宽2～3 mm，表面光滑；Nd∶YAG激光吻合后的创口宽4 mm，表面有炭化屑；肝脏回送腹腔时没有开裂现象。术后1天吻合口局部有明显充血水肿，3天后充血水肿不明显，吻合口收缩，12天及28天，吻合口无充血及水肿，表面光滑，与腹腔无粘连，愈合好。
镜下所见：照射后即刻吻合口表面至深层有三个组织层次，表面为炭化组织，中间为凝固组织，深层为出血充血组织，内有少量白细胞浸润。术后1天组织充血，水肿明显，白细胞增多。术后3天，深层组织内有大量白细胞存在并开始有纤维组织生长。术后12天，可见纤维组织大量生长，白细胞数量减少，炭化组织开始吸收。28天时创口已纤维化，大部分炭化组织已吸收。Nd∶YAG激光照射对组织的穿透度较CO2激光深，对周围组织的损伤较CO2激光明显，炭化、凝固、充血出血3个层次的改变也较CO2激光分明。
, http://www.100md.com
讨论
激光对生物组织作用的影响因素主要有波长、功率、照射时间、能量密度及靶组织的特性等。CO2激光的波长为10.6 μm，主要为组织中的水分吸收；Nd∶YAG激光的波长约1.06 μm，主要为褐色的组织与血红蛋白吸收。两种激光随着功率的增高，都可使组织融合、炭化以至汽化。本实验采用较低功率的激光照射，尽量使组织融合而避免炭化。由于创口较长，有渗血处和无渗血处吻合时需要的能量不一样，术中调节机器旋钮多有不便，主要靠变化照射距离来调节能量，因此，照射时能量密度的波动较大，幅度均约为4.5倍。切口处有无出血，是影响吻合的最重要因素，流动的血液易将激光能量带走，切口不易吻合。肝破裂传统的治疗多采用肝切除、大网膜修补等方法。本实验的目的在于探讨激光吻合肝破裂的可行性。实验中未做两种激光重叠照射，以比较其差异。初步结果表明，两种激光均可有效地吻合肝切创，CO2激光对周围组织的损伤较小，而Nd∶YAG激光更适合于切口较深、渗血较多的肝脏切创吻合。
, http://www.100md.com
参考文献
[1]Goldman L.Future of laser dermatology.Lasers Surg Med,1998,22:3-8.
[2]吴明营，李天德，李峻亨，等. 国产激光机心肌再血管化的初步临床应用.中国激光医学杂志，1996，5:3-6.
[3]施虹敏，朱菁，戴胜国，等. Ho∶YAG激光治疗膀胱癌. 中国激光医学杂志，1998，7:73-75.
[4]Bass LS, Treat MR. Laser tissue welding: a comprehensive review of current and future clinical applications. Lasers Surg Med, 1995, 17:315-349.
, 百拇医药
[5]Menovsky T, Beek JF, van Gemert MJ. Laser tissue welding of dura mater and peripheral nerves: a scanning electron microscopy study. Lasers Surg Med, 1996, 19:152-158.
[6]Cilesiz I, Springer T, Thomsen S, et al. Controlled temperature tissue fusion: argon laser welding of canine intestine in vitro. Lasers Surg Med, 1996, 18:325-334.
(收稿日期：1998-08-20), http://www.100md.com
单位：徐遵迪(济南军区总医院250031)；李峻亨 李维华(解放军总医院)
关键词：激光；肝破裂
中国激光医学杂志990107摘要
目的 探讨CO2激光和Nd∶YAG激光吻合肝切创的可行性，为临床应用激光吻合肝破裂提供实验依据。
方法 普通家犬5只，静脉麻醉后剖腹，暴露肝脏，在其表面做两条长2～5 cm、深4～10 mm切口。分别用CO2激光和Nd∶YAG激光照射创口，CO2激光的输出功率为3 W，照射距离0.5～2.0 cm，光斑直径0.2 cm，垂直照射20～90 s，能量密度1 910～8 595 J/cm2；Nd∶YAG激光光纤末端功率为5 W，照射距离0.3～0.5 cm，光斑直径0.4 cm，垂直照射20～90 s，能量密度为800～3 600 J/cm2。术后即刻、1、3、12和28天各处死1只家犬，取切口处肝组织，做病理检查，观察切口愈合情况。
, http://www.100md.com
结果 肉眼观察，照射即刻创口的出血迅速停止，创口紧闭，CO2激光吻合后的创口宽2～3 mm，表面光滑，Nd∶YAG激光吻合后的创口宽4 mm，表面有炭化屑；术后12天及28天，创口表面光滑，愈合良好。镜下观察，照射后即刻的吻合口表面至深层有3个组织层次，表面为炭化组织，中间为凝固组织，深层为出血充血组织；28天时创口已纤维化，炭化组织已吸收。
结论 CO2激光和Nd∶YAG激光均可以有效地吻合肝切创，CO2激光对周围组织的损伤较小，而Nd∶YAG激光对渗血创口的吻合较CO2激光更为有效。
CO2 Laser and Nd∶YAG Laser Irradiation for Liver Incision Closure in Dogs
XU Zundi1, LI Junheng2, LI Weihua2
, 百拇医药
1.General Hospital of Jinan Command, Jinan 250031 2.Chinese PLA General Hospital,Beijing
ABSTRACT
Objective The feasibility of CO2 laser and Nd∶YAG laser closure in sealing of dog liver incisions was studied.
Methods Five healthy adult dogs of either sex were anesthetized with intravenously administered sodium thiopental(50 mg/kg). Using sterile operative technique the livers were exposed and two incisions were made with scalpel on its surface. The incisions length was 2-5 cm and depth was 4-10 mm. CO2 laser: The power output was 3 W, vertical irradiation distance was 0.5-2.0 cm, spot diameter was 0.2 cm, irradiation time was 20-90 s, energy density was 1 910-8 595 J/cm2. Nd∶YAG laser：Power at the fiber tip was 5 W, vertical irradiation distance was 0.3-0.5 cm, spot diameter was 0.4 cm, irradiation time was 20-90 s, energy density was 800-3 600 J/cm2. The animals were killed at 0,1,3,12 and 28 days after sealing, respectively, and histological changes were examined by routine light microscopy.
, http://www.100md.com
Results Macroscopic findings: No blood leaks were noted from all the sealed incisions. Immediately after sealing, the CO2 laser lesions appeared as a 2-3 mm zone, while the Nd∶YAG laser lesions showed a narrow band (about 4 mm) of coagulated and necrotized tissue. Both the CO2 laser and Nd∶YAG laser closures were firm and tight. There were no breaks in all lesions and the livers were put back into the abdominal cavity. At 12 and 28 days after operation, the incision cut were healed excellently. Microscopic findings: Immediately after sealing, there were three layers of changes from surface to depths: canbonization, coagulation and congestion. Fibrous tissues were found in incision after 28 days. The irradiation damage caused by Nd∶YAG laser adjacent to the closure was more evident than that of CO2 laser.
, 百拇医药
Conclusions This preliminary experiment showed that both CO2 laser and Nd∶YAG laser may be used to seal the ruputure of liver. The damage caused by CO2 laser closure is milder than that of Nd∶YAG laser. However, Nd∶YAG laser is more useful to melt bleeding tissues and may be more effective for larger hepatorrhexis.
Key words Lasers; Hepatorrhexis
临床治疗工作中将激光作为一种切割、烧灼组织的手段，已有大量报道[1-3]，近年来又陆续有低功率激光吻合血管、神经、皮肤等的研究报道[4-6]。为探讨激光吻合肝破裂的可行性，我们进行了CO2激光和Nd∶YAG激光吻合肝切创的实验研究。
, http://www.100md.com
材料和方法
普通家犬5只(由解放军总医院动物实验室提供)，体重10～15 kg，硫贲妥钠50 mg/kg静脉麻醉，剖腹暴露肝脏，于肝脏表面做两条长2～5 cm、深4～10 mm的切口，随机分别采用CO2激光和Nd∶YAG激光进行吻合。CO2激光的输出功率为3 W，照射距离0.5～2.0 cm，光斑直径0.2 cm，垂直照射20～90 s，能量密度1 910～8 595 J/cm2；Nd∶YAG激光光纤末端功率为5 W，照射距离0.3～0.5 cm，光斑直径0.4 cm，垂直照射20～90 s，能量密度为800～3 600 J/cm2。两种激光不重叠照射。术后即刻、1、3、12和28天各处死1只家犬，取切口处肝组织，切片，苏木精-伊红染色，做病理学检查。未即刻处死的家犬只做手术切口简要包扎及一般护理，无特殊处理。
结果
, http://www.100md.com
肉眼所见：照射即刻创口的出血迅速停止，创口闭紧，Nd∶YAG激光的止血效果较CO2激光好，更适合渗血较多的创口。CO2激光吻合后的创口宽2～3 mm，表面光滑；Nd∶YAG激光吻合后的创口宽4 mm，表面有炭化屑；肝脏回送腹腔时没有开裂现象。术后1天吻合口局部有明显充血水肿，3天后充血水肿不明显，吻合口收缩，12天及28天，吻合口无充血及水肿，表面光滑，与腹腔无粘连，愈合好。
镜下所见：照射后即刻吻合口表面至深层有三个组织层次，表面为炭化组织，中间为凝固组织，深层为出血充血组织，内有少量白细胞浸润。术后1天组织充血，水肿明显，白细胞增多。术后3天，深层组织内有大量白细胞存在并开始有纤维组织生长。术后12天，可见纤维组织大量生长，白细胞数量减少，炭化组织开始吸收。28天时创口已纤维化，大部分炭化组织已吸收。Nd∶YAG激光照射对组织的穿透度较CO2激光深，对周围组织的损伤较CO2激光明显，炭化、凝固、充血出血3个层次的改变也较CO2激光分明。
, http://www.100md.com
讨论
激光对生物组织作用的影响因素主要有波长、功率、照射时间、能量密度及靶组织的特性等。CO2激光的波长为10.6 μm，主要为组织中的水分吸收；Nd∶YAG激光的波长约1.06 μm，主要为褐色的组织与血红蛋白吸收。两种激光随着功率的增高，都可使组织融合、炭化以至汽化。本实验采用较低功率的激光照射，尽量使组织融合而避免炭化。由于创口较长，有渗血处和无渗血处吻合时需要的能量不一样，术中调节机器旋钮多有不便，主要靠变化照射距离来调节能量，因此，照射时能量密度的波动较大，幅度均约为4.5倍。切口处有无出血，是影响吻合的最重要因素，流动的血液易将激光能量带走，切口不易吻合。肝破裂传统的治疗多采用肝切除、大网膜修补等方法。本实验的目的在于探讨激光吻合肝破裂的可行性。实验中未做两种激光重叠照射，以比较其差异。初步结果表明，两种激光均可有效地吻合肝切创，CO2激光对周围组织的损伤较小，而Nd∶YAG激光更适合于切口较深、渗血较多的肝脏切创吻合。
, http://www.100md.com
参考文献
[1]Goldman L.Future of laser dermatology.Lasers Surg Med,1998,22:3-8.
[2]吴明营，李天德，李峻亨，等. 国产激光机心肌再血管化的初步临床应用.中国激光医学杂志，1996，5:3-6.
[3]施虹敏，朱菁，戴胜国，等. Ho∶YAG激光治疗膀胱癌. 中国激光医学杂志，1998，7:73-75.
[4]Bass LS, Treat MR. Laser tissue welding: a comprehensive review of current and future clinical applications. Lasers Surg Med, 1995, 17:315-349.
, 百拇医药
[5]Menovsky T, Beek JF, van Gemert MJ. Laser tissue welding of dura mater and peripheral nerves: a scanning electron microscopy study. Lasers Surg Med, 1996, 19:152-158.
[6]Cilesiz I, Springer T, Thomsen S, et al. Controlled temperature tissue fusion: argon laser welding of canine intestine in vitro. Lasers Surg Med, 1996, 18:325-334.
(收稿日期：1998-08-20), http://www.100md.com