White R A, Kopchok G E, Donayre C E, Peng S K, Fujitani R M, White G H, Uitto J
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Lasers Surg Med. 1988;8(1):83-9. doi: 10.1002/lsm.1900080115.
The mechanism of laser vascular tissue welding remains unknown. This study compared the acute tissue response and long-term healing of sutured and laser-welded anastomoses of vein segments used to bypass ligated canine femoral arteries. For each procedure, one anastomosis was formed using running 6-0 polypropylene suture (control), and the other anastomosis was formed using argon laser tissue welding (experimental). The vein grafts were harvested at 4 (n = 2), 8 (n = 1), 12 (n = 1), and 16 (n = 2) weeks, and selected samples were evaluated by histologic examination, electron microscopy, tensile strength testing, and by measuring the formation of [3H]hydroxyproline as an index of collagen synthesis. Examination of successful laser fusions immediately after they were formed showed bonding of collagen to collagen and elastin to collagen. Follow-up evaluations showed that the precision of tissue apposition affected the rate of healing and tensile strength. Laser-welded anastomoses demonstrated a progression of healing similar to sutured repairs, with remodeling of fibrous tissue and collagen being the primary component of weld integrity. This study demonstrates that sutured and argon laser-welded vein-artery anastomoses heal comparably up to 16 weeks postoperatively, and that laser welding is a satisfactory alternative to sutured anastomoses.
激光血管组织焊接的机制尚不清楚。本研究比较了用于绕过结扎犬股动脉的静脉段缝合和激光焊接吻合术的急性组织反应和长期愈合情况。对于每个手术，一个吻合口采用连续6-0聚丙烯缝线形成（对照），另一个吻合口采用氩激光组织焊接形成（实验）。在4周（n = 2）、8周（n = 1）、12周（n = 1）和16周（n = 2）时采集静脉移植物，对选定的样本进行组织学检查、电子显微镜检查、拉伸强度测试，并通过测量[3H]羟脯氨酸的形成作为胶原合成指标进行评估。对成功形成后的激光融合立即进行检查，结果显示胶原与胶原以及弹性蛋白与胶原之间存在结合。随访评估表明，组织贴合的精度影响愈合速度和拉伸强度。激光焊接吻合术显示出与缝合修复相似的愈合过程，纤维组织和胶原的重塑是焊接完整性的主要组成部分。本研究表明，缝合和氩激光焊接的静脉-动脉吻合术在术后16周内愈合情况相当，并且激光焊接是缝合吻合术的一种令人满意的替代方法。
