不同功率CO2激光对声带损伤的实验研究

Experimental study on different power CO2 laser for vocal cord injury

目的 观察不同功率CO2激光对声带上皮下切除后的损伤和修复.方法 采用30只实验犬随机分成A（1 W）、B（3 W）、C（5W）、D（8W）、E（冷器械）5组,每组6只,分别行声带上皮下切除术,观察比较组织损伤及术后不同时间创面修复情况.结果 C、D组创面黏膜反应较A、B、E组重,创面愈合慢,可见病理性瘢痕.光学显微镜下测定单位面积成纤维细胞数量及毛细血管数量,C、D组明显高于A、B、E组,差异有统计学意义（P值均＜0.05）.电镜下观察发现A、B、E组损伤较轻,声带修复过程无明显差别,而C、D组损伤较重,声带修复后成固有层内弹力纤维稀少,胶原纤维明显增多.结论 CO2激光采用低功率（1～3 W）行声带上皮下切除术,组织修复结果与冷器械手术相似.

Objective To observe the injury and repair of the subepithelial cordectomy by CO2 laser in different power.Methods Thirty dogs were randomly divided into 5 groups according to different laser power such as A（1 W）,B（3 W）,C（5 W）,D（8 W）,E（cold instruments）,6 dogs in each group.Subepithelial cordectomy was performed on the dogs and the tissue damage and wound recovery were observed in different time after operation.Results The mucosa reaction in group C,D was heavier than those in group A,B,E,and the wounds healed slowly with visible pathological scars.The densities of fibroblast and blood capillary were determined with optical microscope.It was found that those in group C,D were higher than those in group A,B,E.The difference was statistically significant（average P 〈 0.05）.Observation by electron microscope showed that the injuries were lighter in group A,B,E and there was no significant difference in vocal cord repair process,while the injuries were more serious in group C,D with few elastic fibers in lamina propria and collagen fibers increased significantly after vocal cord repairing.Conclusion The tissue repair after subepithelial cordectomy by CO2 laser with low power（1-3 W）was similar to that by cold instrument surgery.