Hosten N, Stier A, Weigel C, Kirsch M, Puls R, Nerger U, Jahn D, Stroszczynski C, Heidecke C-D, Speck U
Abteilung für Diagnostische und Interventionelle Radiologie, Klinikum der Ernst-Moritz-Arndt Universität Greifswald.
Rofo. 2003 Mar;175(3):393-400. doi: 10.1055/s-2003-37830.
A thin-caliber applicator system was developed for introducing a laser fiber under CT guidance into lung metastases with only minimal complications.
A space-saving 5.5 French Teflon cannula with a titanium trocar and connectors for a laser light guide (2 or 3 cm Dornier Diffusor-Tip H-6111-T2 or H-6111-T3 coupled to a Dornier Medilas Fibertom 5100 laser, wavelength of 1064 nm) and a perfusion line for physiologic saline solution were developed. After puncture the laser Diffusor-Tip remains in the cannula and is cooled during its tissue passage by slowly flowing saline solution. The miniaturized applicator system (Monocath) was calibrated in nonperfused bovine liver for maximum energy supply and necessary flow of the cooling saline solution in reference to a commercially available 9 French laser catheter with an 11.5 French inducer sheath (Power-Applicator). The new applicator system was used for treating lung metastases in 10 patients over a period of 21 months.
The size of heat coagulation in bovine liver was 24 +/- 2 ml using the miniaturized system with application of 15 W for 20 min and a saline flow of 0.75 ml/min, in comparison to a size of 29 +/- 7 ml for the commercial applicator (30 W, 20 min, 60 ml/min). All metastases could be safely approached with the miniaturized applicator, except for two metastatic lesions at the lung base in two patients. A minor pneumothorax developed in three patients and intrapulmonary bleeding in two. Contrast-enhanced CT demonstrated necrosis of the treated metastatic areas in 6 patients. Follow-up of three patients after 5, 6, and 8 months showed complete tumor regression with minimal scarring in one patient.
The miniaturized applicator system enables the introduction of a laser fiber into pulmonary metastases with only minor complications. Complete ablation seems to be achievable in suitable patients with the applied laser energy and a slow cooling fluid flow rate.
开发一种细口径的施源器系统，用于在CT引导下将激光光纤引入肺转移瘤，且并发症极少。
研制了一种节省空间的5.5法式聚四氟乙烯套管，配有钛制套管针以及用于激光光导（2或3厘米多尼尔扩散头H-6111-T2或H-6111-T3，与多尼尔Medilas Fibertom 5100激光耦合，波长1064纳米）的连接器和用于生理盐水溶液的灌注管路。穿刺后，激光扩散头留在套管内，并在其通过组织过程中由缓慢流动的生理盐水溶液冷却。在未灌注的牛肝中对小型化施源器系统（单腔导管）进行校准，以确定相对于市售的带有11.5法式引导鞘的9法式激光导管（强力施源器）的最大能量供应和冷却生理盐水溶液的必要流速。在21个月的时间里，该新型施源器系统用于治疗10例患者的肺转移瘤。
使用小型化系统，在15瓦功率下施加20分钟且生理盐水流速为0.75毫升/分钟时，牛肝中的热凝大小为24±2毫升，相比之下，市售施源器（30瓦，20分钟，60毫升/分钟）的热凝大小为29±7毫升。除两名患者肺底部的两个转移病灶外，所有转移瘤均可通过小型化施源器安全到达。3例患者发生轻度气胸，2例患者发生肺内出血。增强CT显示6例患者治疗后的转移区域出现坏死。5、6和8个月后对3例患者的随访显示，1例患者肿瘤完全消退，瘢痕极小。
小型化施源器系统能够将激光光纤引入肺转移瘤，并发症轻微。对于合适的患者，应用所施加的激光能量和缓慢的冷却液流速似乎可实现完全消融。
