Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Am J Rhinol Allergy. 2010 May-Jun;24(3):244-6. doi: 10.2500/ajra.2010.24.3463.
Adequate repair of cerebrospinal fluid leak remains a significant challenge in endoscopic skull base surgery. Laser tissue welding (LTW) is a method of creating an instant watertight wound closure using a chromophore doped biological solder, which may be used for cranial base reconstruction. The objective of this study is to assess the safety and technical feasibility of endoscopic LTW in human sinonasal mucosa.
A prospective, Institutional Review Board-approved study was performed of 10 patients undergoing endoscopic LTW using an albumin and hyaluronic acid-based solder for repair of mucosal injuries. Data were collected on patient demographics, total lasing time, and volume of solder used. Wounds were prospectively followed by endoscopic exam and scored on a scale of zero to two by three blinded observers (B.S.B., J.N.P., and A.G.C.) for inflammation, thermal injury, and edema. Results were compared with control wounds using the Mann-Whitney U test.
Ten patients (seven men and three women; average age 50 years; range, 33-71 years) underwent endoscopic LTW. Total lasing time was 11 +/- 11 minutes requiring 0.96 +/- 0.83 mL of solder per patient. Patients were followed for an average of 72 days (range, 12-138 days) and no complications were noted. Solder persisted for up to 26 days and there was no significant difference between the lased and control wounds with regard to inflammation (0.87 +/- 0.72 versus 1.31 +/- 0.87), thermal injury (0.06 +/- 0.25 versus 0.12 +/- 0.34), or edema scores (1.13 +/- 0.81 versus 1.44 +/- 0.73).
Endoscopic LTW is a technically feasible and rapid method of wound closure in sinonasal mucosa that does not result in any significant thermal or inflammatory sequelae.
在鼻内镜颅底手术中，充分修复脑脊液漏仍然是一个重大挑战。激光组织焊接（LTW）是一种使用掺有发色团的生物焊料即刻实现水密性伤口闭合的方法，可用于颅底重建。本研究旨在评估内镜 LTW 在人鼻黏膜中的安全性和技术可行性。
对 10 例接受内镜 LTW 修复黏膜损伤的患者进行前瞻性、机构审查委员会批准的研究。收集患者人口统计学数据、总激光时间和使用的焊料量。通过内镜检查前瞻性随访伤口，并由 3 名盲法观察者（B.S.B.、J.N.P. 和 A.G.C.）对炎症、热损伤和水肿进行零到 2 分的评分。使用 Mann-Whitney U 检验将结果与对照伤口进行比较。
10 例患者（7 例男性，3 例女性；平均年龄 50 岁；范围 33-71 岁）接受了内镜 LTW。总激光时间为 11 ± 11 分钟，每位患者需要 0.96 ± 0.83 毫升的焊料。患者平均随访 72 天（范围 12-138 天），无并发症发生。焊料持续存在长达 26 天，在炎症（0.87 ± 0.72 与 1.31 ± 0.87）、热损伤（0.06 ± 0.25 与 0.12 ± 0.34）或水肿评分（1.13 ± 0.81 与 1.44 ± 0.73）方面，激光处理的伤口与对照伤口之间无显著差异。
内镜 LTW 是一种在鼻黏膜中快速且可行的伤口闭合方法，不会引起任何明显的热或炎症后遗症。
