450 nm半导体蓝激光对肾盂组织汽化切割效应的离体动物实验研究

Effects of 450 nm diode blue laser on the vaporization and incision of renal pelvis tissue ex vivo

目的 探究450 nm半导体蓝激光在不同作用距离、功率下汽化切割肾盂组织后的形态和热损伤范围。方法 将新鲜离体猪肾盂纵行剖开,切成约7 cm×5 cm×3 cm的方块。激光光纤固定在垂直于肾盂组织的机械臂上,光纤头与肾盂组织距离1~2 mm,以1~2 mm/s的恒定速度对肾盂组织进行切割,蓝激光功率5~30 W,再将切割后的肾盂组织固定于福尔马林中,采用肉眼及显微镜评估其形态、汽化深度、宽度及凝固厚度。结果 使用不同功率汽化肾盂组织时汽化效果不同,作用距离为2 mm、速度为2 mm/s,当激光功率为5 W时,汽化深度约0.9 mm,汽化宽度约0.25 mm,凝固层厚度约0.35 mm。随着功率的增加汽化宽度和深度随之增加,而凝固层范围即热损伤厚度介于0.35~0.50 mm;当功率大于10 W时,肾盂肌层组织易被穿透;当激光功率为20 W时,肾盂组织被汽化后组织切面呈现不规则的汽化效果。当激光作用距离为1 mm时,肾盂肌层组织容易被全层汽化;而激光汽化距离为2 mm、速度为2 mm/s时产生了较安全的能量治疗窗口。结论 450 nm半导体蓝激光可对肾盂组织进行安全有效的汽化切割,精准度高且热损伤小,有望用于临床成为治疗肾盂内病变的新的手术工具。

Objective To investigate the effects of 450 nm diode blue laser on the morphological changes and thermal damage of renal pelvis under different conditions.Methods An ex vivo study was conducted on a fresh porcine pelvis model(7 cm×5 cm×3 cm).The laser fiber was fixed on the mechanical arm perpendicular to the renal pelvis tissue, and the distance between them was 1-2 mm.The renal pelvis tissue was incised at a speed of 1-2 mm/s and power of 5-30 W.After the incised tissue was fixed in formalin(4%),the morphology, depth, width and coagulation thickness were observed with naked eyes and a microscope.Results The different powers had different vaporization and incision effects.When the operating distance was 2 mm, the speed was 2 mm/s and power was 5 W,the vaporization depth, width and coagulation thickness were approximately 0.9 mm, 0.25 mm and 0.35 mm, respectively.With the increase of power, the vaporization width and depth increased, and the coagulation thickness was 0.35-0.50 mm.When the power was more than 10 W,the renal pelvis tissue was easily penetrated.When the laser power was 20 W,the section of the renal pelvis showed an irregular shape of vaporization.When the operating distance was 1 mm, the whole renal pelvis tissue was easily vaporized.When it was 2 mm, a wide and safe energy treatment window was produced.Conclusion The 450 nm diode blue laser can vaporize and incise renal pelvis tissue safely and effectively, with high precision and little thermal damage.It is expected to be a new surgical tool in the treatment of renal pelvis lesions.