450 nm半导体蓝激光对子宫内膜组织汽化切割效应的离体动物实验研究

Efftects of 450 nm semiconductor blue laser on the vaporization and incision of endometrial tissue ex vivo

目的使用450 nm半导体蓝激光手术系统在不同条件下对离体新鲜猪子宫内膜组织进行汽化切割及内镜下模拟手术实验,初步评估蓝激光在妇科手术应用中的安全性、有效性和可行性。方法取产后和未孕新鲜猪离体子宫各8个,使用450 nm纤芯光纤,步进机移动速度为1.0 mm/s、2.0 mm/s,光纤头距离组织0.5~1.0 mm,调试蓝激光功率为5~30 W等条件下对猪子宫内膜组织进行汽化切割,对汽化切割后的标本行拍照记录后,置入4%多聚甲醛内固定48小时,使用游标卡尺测量凝固范围、汽化宽度、汽化深度,将标本行HE染色。使用产后子宫8个,对比等离子电切设备,在体外内镜辅助下进行模拟手术操作,将术后的标本行HE染色。结果激光在不同的功率(5~25 W)下作用于子宫内膜组织,随着激光功率的增大,组织的汽化深度、汽化宽度也逐渐增大;使用双极等离子电切设备与蓝激光在内镜下行汽化切割实验的比较,结果发现蓝激光汽化切割创面更平整,无明显碳化层,热损伤范围局限可控,凝固层、汽化深度及宽度稳定。相较于等离子电切设备,蓝激光产生的热损伤范围相对较小。结论初步研究表明,蓝激光进行猪子宫内膜相关手术是安全、有效且可行的,并且有望成为可选择的一种新型的妇科激光手术设备。

Objective The 450 nm semiconductor blue laser surgical system was used to perform vaporization and incision of fresh endometrial tissue ex vivo under different conditions and endoscopic simulated surgery experiments to initially evaluate the safety,efficacy and feasibility of blue laser in gynecological surgical applications.Method 8 fresh uteri were taken from each of the pregnant and non-pregnant swines.Vaporization and incision of endometiral tissue was performed using 450 nm core fiber.The moving speed of the stepper(V)is 1.0 mm/s,2.0 mm/s,the distance(D)of the fiber head is adjusted to 0.5~1.0mm from the tissue,and the power of the laser is 5~30 W.Photographs a?ter vaporization were recorded,and specimens were put into 4%paraformaldehyde for HE test.Vernier caliper was used to measure the thickness of the coagulation,width and depth of the vaporization.8 postpartum uteri were used,and in contrast with plasma electrocut equipment,vitro simulated operation was done under the endoscope assisted.The specimens of postoperation was done HE staining.Result Blue laser acts on the endometrial tissue at different power(5~25 W),and as the laser power increases,the vaporization depth and vaporization width of the tissue gradually increases.A comparison of vaporization cutting experiments using a bipolar plasma electrosurgery device with the blue laser under endoscopy showed that the cut surface of blue laser was flatter.There was no obvious carbonization layer after the vaporization of the blue laser.The range of thermal damage for the blue laser was limited and controllable,and the thickness of the coagula-tion,the depth and width of the vaporization were stable.Compared to plasma electrocut equipment,the blue laser produces a relatively small range of thermal damage.Conclusion We concluded that the blue laser is a safe,effective and feasible surgical instrument for the treatment of the endometrial lesions.And the blue laser should be expected to become a new apparatus for physician of the department of gynaecology.