Akkermans Joost, van der Donk Loes, Peeters Suzanne H P, van Tuijl Sjoerd, Middeldorp Johanna M, Lopriore Enrico, Oepkes Dick
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Fetal Diagn Ther. 2017;42(3):204-209. doi: 10.1159/000464323. Epub 2017 Mar 29.
To assess the impact of laser power and firing angle on coagulation efficiency for closing placental anastomoses in the treatment of twin-twin transfusion syndrome.
We used an ex vivo blood-perfused human placenta model to compare time to complete coagulation using 30 vs. 50 W of neodymium-doped yttrium aluminum garnet laser power and using a firing angle of 90° vs. 45°. Placentas were perfused with pig blood at 5 mL/min. Differences were analyzed using independent-samples t test, Mann-Whitney U test, or χ2 test as appropriate.
Coagulation took less time and energy using 50 W (n = 53) compared to 30 W (n = 52), 11 vs. 22 s (p < 0.001), and 557 vs. 659 J (p = 0.007). Perpendicular coagulation (n = 53) took less time and energy compared to a 45° angle (n = 21), 11 vs. 17 s (p = 0.004), and 557 vs. 871 J (p = 0.004). Bleeding complicated 2 (3%) measurements in the 50-W group, 5 (10%) in the 30-W group, and 3 (14%) in the 45° group.
In a highly controlled model, a 50-W laser power setting was more energy efficient than 30 W in coagulating a placental vein. A more perpendicular laser firing angle resulted in more efficient coagulation. Furthermore, bleeding due to vessel wall disruption occurred more often with lower power and a more tangential approach.
评估激光功率和发射角度对双胎输血综合征治疗中封闭胎盘吻合口时凝血效率的影响。
我们使用体外血液灌注的人胎盘模型，比较使用30瓦与50瓦掺钕钇铝石榴石激光功率以及90°与45°发射角度时完成凝血的时间。胎盘以5毫升/分钟的速度灌注猪血。根据情况使用独立样本t检验、曼-惠特尼U检验或χ²检验分析差异。
与30瓦（n = 52）相比，使用50瓦（n = 53）时凝血所需时间和能量更少，分别为11秒对22秒（p < 0.001），以及557焦耳对659焦耳（p = 0.007）。与45°角度（n = 21）相比，垂直凝血（n = 53）所需时间和能量更少，分别为11秒对17秒（p = 0.004），以及557焦耳对871焦耳（p = 0.004）。50瓦组有2次（3%）测量出现出血并发症，30瓦组有5次（10%），45°组有3次（14%）。
在高度受控的模型中，50瓦的激光功率设置在凝结胎盘静脉方面比30瓦更节能。更垂直的激光发射角度导致凝血更有效。此外，较低功率和更切向的方法导致血管壁破裂引起的出血更频繁。
