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在一项猪体内研究中,比较 1.92μm 光纤激光与标准高频电刀在保留肾单位肾部分切除术中的应用。

Comparison between a 1.92-μm fiber laser and a standard HF-dissection device for nephron-sparing kidney resection in a porcine in vivo study.

机构信息

Institute of Biomedical Optics (BMO), University of Lübeck, Peter Monnik Weg 4, 23538, Lübeck, Germany.

出版信息

Lasers Med Sci. 2011 Jul;26(4):509-14. doi: 10.1007/s10103-010-0873-y. Epub 2011 Jan 18.

Abstract

Nephron-sparing surgery was performed in a porcine model with a 1.92-μm fiber laser dissection device in comparison to a standard high-frequency dissection device. In nine pigs, general anesthesia and a median laparotomy were performed to expose both kidneys. On six kidneys (three HF and three laser) a partial renal parenchyma resection of the lower pole without opening of the renal pelvis was performed (group A). On 12 kidneys (four HF and eight laser), a hemi nephrectomy with opening of the renal pelvis was performed (group B). Total resection time including hemostasis of the remaining tissue was 501 ± 394 s in group "A-laser " vs. 176 ± 139 s in group "A-HF". For the group "B", the total resection time was 1174 ± 501 s (B laser) vs. 960 ± 407 s (B-HF). Blood loss was 28 ± 22 ml in group "A laser " vs. 15 ± 15 ml in group "A-HF". In group "B", the blood loss was 98 ± 73 ml (B laser) vs. 137 ± 118 ml (B-HF). No ischemic time for the kidneys was needed in group "A" for both dissection devices. In group "B", ischemia of the kidneys was performed three times during the eight laser procedures (420 ± 60 s) and only once at the four HF procedures (1,260 s). Healing process was observed over 4-6 weeks, survival rate was 100%, and no renal fistulas were found after the survival period. In conclusion, no significant differences were found between the compared dissection devices. However, the laser system with the flexible transmission fiber may have an advantage for a laparoscopic approach by steerable instruments.

摘要

在猪模型中,使用 1.92μm 光纤激光切割设备进行了保肾手术,与标准高频切割设备进行了比较。在 9 头猪中,进行全身麻醉和正中剖腹术以暴露双侧肾脏。在 6 个肾脏(3 个 HF 和 3 个激光)上进行了不打开肾盂的下极部分肾实质切除术(A 组)。在 12 个肾脏(4 个 HF 和 8 个激光)上进行了肾盂切开的半肾切除术(B 组)。包括剩余组织止血在内的总切除时间,A 组激光为 501±394s,A 组 HF 为 176±139s。对于 B 组,总切除时间为 1174±501s(B 激光)与 960±407s(B-HF)。A 组激光的失血量为 28±22ml,A 组 HF 为 15±15ml。B 组激光的失血量为 98±73ml,B 组 HF 为 137±118ml。对于两种切割设备,A 组均无需进行肾脏缺血时间。在 B 组中,在 8 个激光手术中,肾脏缺血时间为 3 次(420±60s),在 4 个 HF 手术中仅为 1 次(1260s)。在 4-6 周的观察期内观察到愈合过程,存活率为 100%,在存活期后未发现肾瘘。总之,两种切割设备之间未发现明显差异。然而,带有柔性传输光纤的激光系统可能在腹腔镜手术中具有通过可转向器械的优势。

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