泌尿外科常用激光系统与组织的相互作用研究
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摘要
目的:针对激光在腹腔镜手术和尿路狭窄腔镜下内切开术应用中存在的问题,探讨改善现有应用效果的可能方法并进行体外实验评估。方法:分别采用铥激光和飞秒脉冲激光对离体犬肾组织和猪输尿管组织进行体外实验,观察(1)在模拟腹腔条件下,低流量冲洗液抑制铥激光产生烟雾的效果和(2)飞秒脉冲激光切割离体猪输尿管的效率与副损伤程度。结果:低流量冲洗液可显著减少铥激光在模拟腹腔条件下产生烟雾的速度(下降至1/5以下,P<0.001);飞秒脉冲激光切割离体猪输尿管的速度为20-100μm/秒左右,副损伤层厚度O-100μm。结论:在激光腹腔镜手术中利用低流量冲洗液可以有效降低烟雾形成速度,改善手术野清晰度;飞秒激光可满足腔镜手术切割输尿管粘膜的要求,且副损伤范围较目前常用的钬激光大幅度减轻。
Objectives: To evaluate potential resolutions to current issues of two aspects of laser applications in urology: laparoscopic and endourologic surgery. Methods: Fresh canine kidneys and porcine ureters were harvested and subjected to thulium laser and femtosecond pulse laser, respectively. The former laser experiment was performedunder different combinations of laser powers and irrigation speeds; the latter was under various pulses and pulse energy. Results: in vitro model showed that low speed irrigation decreased smoke formation significantly (1/5 of base level, P<0.001) during thulium laser irradiation; femtosecond pulse laser incised ureter mucosa with an efficiency of 20-l00μm /sec and a collateral damage range of 0-100μm. Conclusion: Low speed irrigation could dramatically decrease smoke formation and improve surgical view during laser laparoscopic surgery; femtosecond pulse laser would meet the endourologic requirement for urinary incision, with markedly improved collateral damage in comparison with currently being used laser, such as holmium laser.
Objectives: To evaluate potential resolutions to current issues of two aspects of laser applications in urology: laparoscopic and endourologic surgery. Methods: Fresh canine kidneys and porcine ureters were harvested and subjected to thulium laser and femtosecond pulse laser, respectively. The former laser experiment was performedunder different combinations of laser powers and irrigation speeds; the latter was under various pulses and pulse energy. Results: in vitro model showed that low speed irrigation decreased smoke formation significantly (1/5 of base level, P<0.001) during thulium laser irradiation; femtosecond pulse laser incised ureter mucosa with an efficiency of 20-l00μm /sec and a collateral damage range of 0-100μm. Conclusion: Low speed irrigation could dramatically decrease smoke formation and improve surgical view during laser laparoscopic surgery; femtosecond pulse laser would meet the endourologic requirement for urinary incision, with markedly improved collateral damage in comparison with currently being used laser, such as holmium laser.
引文
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1. Parsons RL. The effect of the laser on dog bladders: A preliminary report. J Urol 1966;95:716–717.
2. Narayan P, Tewari A, Schalow E, et al. Transurethral evaporation of the prostate for treatment of benign prostatic hyperplasia: Results in 168 patients with up to 12 months of follow up. J Urol 1997;157:1309–1312.
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21. Kitagawa M, Furuse H, Fukuta K, et al. Holmium:YAG laser resection of the prostate versus visual laser ablation of the prostate and transurethral ultrasound-guided laser induced prostatectomy: A retrospective comparative study. Int J Urol 1998;5:152–156.
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24. Fraundorfer MR, Gilling PJ. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: Preliminary results. Eur Urol 1998;33:69–72.
25. Moody JA, Lingeman JE. Holmium laser enucleation of the prostate with tissue morcellation: Initial United States experience. J Endourol 2000;14:219–223.
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1. Einstein A. Zur quanten Theorie der Strahlung. Phys Zeit 1917;18:121
2. Maiman T. Stimulated optical radiation in ruby. Nature 1960;187:493
3. Parsons RL, Campbell JL, Thomley MW, Butt CG, Gordon TE Jr. The effect of the laser of dog bladders: a preliminary report. J Urol. 1966; 95(5):716-7.
4. Baggish MS. Carbon dioxide laser treatment for condylomata acuminata venereal infections. Obstet Gynecol. 1980; 55(6):711-5.
5. Dougherty TJ. Photodynamic therapy (PDT) of malignant tumors. Crit Rev Oncol Hematol. 1984; 2(2):83-116.
6. Sander S, Beisland HO. Laser in the treatment of localized prostatic carcinoma. J Urol. 1984; 132(2):280-1.
7. Watson GM, Wickham JE. Initial experience with a pulsed dye laser for ureteric calculi. Lancet. 1986 14; 1(8494):1357-8.
8. Fried NM. Therapeutic applications of lasers in urology: an update. Expert Rev Med Devices. 2006; 3(1):81-94. review.
9. Chan KF et al. A prospective on laser lithotripsy: the fragmentation process. J Endourol. 2001; 15(3), 257-273. review.
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18. Fried NM. High-power laser vaporization of the canine prostate using a 110 W Thulium fiber laser at 1.91 microm. Lasers Surg Med. 2005 Jan;36(1):52-6.
19. Narayan P, Tewari A, Schalow E, et al. Transurethral evaporation of the prostate for treatment of benign prostatic hyperplasia: Results in 168 patients with up to
12 months of follow up. J Urol 1997;157:1309–1312.
20. Watson G, Anson K, Janetschek G, et al. An in depth evaluation of contact laser vaporisation of the prostate. J Urol 1994;151:231A.
21. Gilling PJ, Cass CB, Cresswell MD, et al. The use of the holmium laser in the treatment of benign prostatic hyperplasia. J Endourol 1996;10:459–461.
22. Gilling PJ, Cass CB, Cresswell MD, et al. Holmium laser resection of the prostate:Preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology 1996 47:48–51.
23. Gilling PJ, Mackey M, Cresswell M, et al. Holmium laser versus transurethral resection of the prostate: A randomized prospective trial with 1–year followup. J Urol 1999;162:1640–1644.
24. Gilling PJ, Kennett KM, Das AK, et al. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: An update on the early clinical experience. J Endourol 1998;12:457–459.
25. Fraundorfer MR, Gilling PJ. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: Preliminary results. Eur Urol 1998;33:69–72.
26. Moody JA, Lingeman JE. Holmium laser enucleation of the prostate with tissue morcellation: Initial United States experience. J Endourol 2000;14:219–223.
27. Moody JA, Lingeman JE. Holmium laser enucleation for prostate adenoma greater than 100 gm: Comparison to open prostatectomy. J Urol 2001;165:459–462.
28. J Te AE, Malloy TR, Stein BS, et al. Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial.Urol. 2004 Oct;172(4 Pt 1):1404-8.
29. Rosen MA, Nash PA, Bruce JE, McAninch JW. The actuarial success rate of surgical treatment of urethral strictures. J Urol 1994;151:360A.
30. Albers P, Fichtner J, Bruhl P, Muller SC. Long-term results of internal urethrotomy. J Urol 1996;156:1611–1614.
31. Benchekroun A, Lachkar A, Soumana A, Farih MH, Belahnech Z, Marzouk M, Faik M. Internal urethrotomy in the treatment of urethral stenoses (longtermresults). Ann Urol (Paris) 1998;32:99–102.
32. Heyns CF, Steenkamp JW, De Kock ML, Whitaker P.Treatment of male urethral strictures: Is repeated dilation or internal urethrotomy useful? J Urol 1998;160:356–358.
33. McNicholas TA, Colles J, Bown SG, Wickham JEA. Treatment of urethral strictures with a prototype CO2 laser endoscope. Lasers Med Sci 1988;3:427.
34. Adkins WC. Argon laser treatment of urethral stricture and vesical neck contracture. Lasers Surg Med 1988;8:600–603.
35. Becker H Ch, Miller J, Noske HD, Klask JP, Weidner W. Transurethral laser urethrotomy with argon laser: Experience with 900 urethrotomies in 450 patients from 1978–1993. Urol Int 1995;55:150–153.
36. Shanberg A, Baghdassarian R, Tansey L, Sawyer D. K.T.P.532 laser in treatment of urethral strictures. Urology 1988;32:517–520.
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40. Dogra PN, Nabi G. Core-through urethrotomy using the neodymium:YAG laser for obliterative urethral strictures after traumatic urethral disruption and/or distraction defects:Long-term outcome. J Urol 2002;167:543–546.
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42. Singal RK, Denstedt JD, Razvi HA, Chun SS. Holmium:YAG laser endoureterotomy for treatment of ureteral stricture. Urology 1997;50:875–880.
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17. Singal RK, Denstedt JD, Razvi HA, Chun SS. Holmium:YAG laser endoureterotomy for treatment of ureteral stricture. Urology 1997;50:875–880.
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1. Parsons RL. The effect of the laser on dog bladders: A preliminary report. J Urol 1966;95:716–717.
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13. Gilling PJ, Mackey M, Cresswell M, et al. Holmium laser versus transurethral resection of the prostate: A randomized prospective trial with 1–year followup. J Urol 1999;162:1640–1644.
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22. Fraundorfer MR, Gilling PJ, Kennett KM, et al. Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: Results of a randomized prospective study. Urology 2001;57:454–458.
23. Gilling PJ, Kennett KM, Das AK, et al. Holmium laser enucleation of the prostate(HoLEP) combined with transurethral tissue morcellation: An update on the early clinical experience. J Endourol 1998;12:457–459.
24. Fraundorfer MR, Gilling PJ. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: Preliminary results. Eur Urol 1998;33:69–72.
25. Moody JA, Lingeman JE. Holmium laser enucleation of the prostate with tissue morcellation: Initial United States experience. J Endourol 2000;14:219–223.
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27. Bhatta KM. Lasers in urology. Lasers Surg Med 1995;16:312–330.
28. Randall S, Kuntzmann R, Malek R, et al. High power (60W) potassium titanyl phosphate laser vaporization prostatectomy in living canines and in human and canine cadavers. Urology 1997;49:703–708.
29. Carter A, Sells H, O’Boyle P. High power KTP laser for the treatment of symptomatic benign prostatic enlargement. BJU Int 1999; 83:857–858.
30. Hai MA, Malek RS. Photoselective vaporization of the prostate: initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia. J Endourol. 2003 Mar;17(2):93-6.
31. J Te AE, Malloy TR, Stein BS, et al. Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial.Urol. 2004 Oct;172(4 Pt 1):1404-8.
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2. Maiman T. Stimulated optical radiation in ruby. Nature 1960;187:493
3. Parsons RL, Campbell JL, Thomley MW, Butt CG, Gordon TE Jr. The effect of the laser of dog bladders: a preliminary report. J Urol. 1966; 95(5):716-7.
4. Baggish MS. Carbon dioxide laser treatment for condylomata acuminata venereal infections. Obstet Gynecol. 1980; 55(6):711-5.
5. Dougherty TJ. Photodynamic therapy (PDT) of malignant tumors. Crit Rev Oncol Hematol. 1984; 2(2):83-116.
6. Sander S, Beisland HO. Laser in the treatment of localized prostatic carcinoma. J Urol. 1984; 132(2):280-1.
7. Watson GM, Wickham JE. Initial experience with a pulsed dye laser for ureteric calculi. Lancet. 1986 14; 1(8494):1357-8.
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19. Narayan P, Tewari A, Schalow E, et al. Transurethral evaporation of the prostate for treatment of benign prostatic hyperplasia: Results in 168 patients with up to
12 months of follow up. J Urol 1997;157:1309–1312.
20. Watson G, Anson K, Janetschek G, et al. An in depth evaluation of contact laser vaporisation of the prostate. J Urol 1994;151:231A.
21. Gilling PJ, Cass CB, Cresswell MD, et al. The use of the holmium laser in the treatment of benign prostatic hyperplasia. J Endourol 1996;10:459–461.
22. Gilling PJ, Cass CB, Cresswell MD, et al. Holmium laser resection of the prostate:Preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology 1996 47:48–51.
23. Gilling PJ, Mackey M, Cresswell M, et al. Holmium laser versus transurethral resection of the prostate: A randomized prospective trial with 1–year followup. J Urol 1999;162:1640–1644.
24. Gilling PJ, Kennett KM, Das AK, et al. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: An update on the early clinical experience. J Endourol 1998;12:457–459.
25. Fraundorfer MR, Gilling PJ. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: Preliminary results. Eur Urol 1998;33:69–72.
26. Moody JA, Lingeman JE. Holmium laser enucleation of the prostate with tissue morcellation: Initial United States experience. J Endourol 2000;14:219–223.
27. Moody JA, Lingeman JE. Holmium laser enucleation for prostate adenoma greater than 100 gm: Comparison to open prostatectomy. J Urol 2001;165:459–462.
28. J Te AE, Malloy TR, Stein BS, et al. Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial.Urol. 2004 Oct;172(4 Pt 1):1404-8.
29. Rosen MA, Nash PA, Bruce JE, McAninch JW. The actuarial success rate of surgical treatment of urethral strictures. J Urol 1994;151:360A.
30. Albers P, Fichtner J, Bruhl P, Muller SC. Long-term results of internal urethrotomy. J Urol 1996;156:1611–1614.
31. Benchekroun A, Lachkar A, Soumana A, Farih MH, Belahnech Z, Marzouk M, Faik M. Internal urethrotomy in the treatment of urethral stenoses (longtermresults). Ann Urol (Paris) 1998;32:99–102.
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