半导体激光ICG白蛋白吻合中等动脉实验研究

Diode Laser Anastomoses of Medium-size Arteries with Indocyanine Green Dyeenhanced Albumin

为取得更好的血管吻合远期通畅率和解决目前激光血管吻合强度不理想的问题，我们应用半导体激光和加靛蓝花青染料（ＩＣＧ）白蛋白，比较三种不同吻合方法：直接吻合法、单纯白蛋白“焊接”吻合法和直接吻合法加焊接吻合法。吻合材料为离体人胸廓内动脉、活体大白鼠腹主动脉及离体猪心脏和胸廓内动脉。结果表明，平均完成一个吻合口的时间为３．１５ｍｉｎ±０．３６ｍｉｎ；使用白蛋白加固或焊接吻合的耐压强度和抗拉强度都显著高于直接吻合法（Ｐ＜０．０５和Ｐ＜０．０１），而且焊接吻合法的热损伤仅限于动脉外膜，深度仅２００μｍ；存活的大白鼠腹主动脉吻合结果满意。激光用于端—侧吻合胸廓内动脉和冠状动脉左前降支，其抗拉强度仍需进一步活体动物实验研究加以改进。

n order to achieve a better long-term patency results and solve the problem of tensile strength in laser artery anastomoses, diode laser and indocyanine green (ICG) enhanced albumin were applied to medium-size artery anastomoses with three different methods, namely, direct laser vascular anastomoses, direct method enforced with ICG albumin, and laser welding combined with ICG albumin as 'solder'. Internal mammary artery (IMA) harvested from patients undergoing coronary bypass procedures, rat abdominal aorta, and in vitro swine heart and IMA were chosen as the experimental materials. The results revealed that only 315 min±036 min were required to complete an anastomosis. The bursting pressure and tensile strength were greater in the groups enforced with ICG albumin and laser welding than that obtained with direct laser anastomosis (P<005 and P<001). In the laser welding group, the thermal damage was limitted in the adventitial layer, only 200 μm in depth. There was also a satisfied result in the in vivo laser welding rat's abdominal aorta. However, endtoside laser welding of IMAcoronary artery with ICG albumin needs further investigation to improve its tensile strength in an in vivo model.