McCarthy W J, Hartz R S, Yao J S, Sottiurai V S, Kwaan H C, Michaelis L L
J Vasc Surg. 1986 Jan;3(1):32-41. doi: 10.1067/mva.1986.avs0030032.
Laser-assisted arterial and venous anastomoses are now feasible. A microscope-guided CO2 laser was used to deliver 60 to 100 mW to anastomose end to end 44 rabbit carotid arteries (1.5 to 2.0 mm) and 27 rabbit vena cavae (4 to 6 mm). These were compared with control arteries repaired with interrupted suture technique. Anastomoses were examined from between 24 hours and 19 weeks. Laser carotid anastomoses yielded 93% patency (41 of 44) and 9% aneurysms (4 of 44), whereas hand-sewn carotid anastomoses produced 91% patency (40 of 44) and no aneurysms. In the vena cava, 26 of 27 laser anastomoses were patent (96%) compared with 19 of 20 (95%) sutured controls. Venous aneurysmal dilatation was seen in 2 of 27 laser (7%) and in 3 of 20 (15%) hand-sewn anastomoses. Histologic examination of laser-assisted anastomoses showed local full-thickness thermal injury. Repair was by fibroblast and myofibroblast proliferation, and luminal cell coverage was complete by 14 days in both laser and sutured repairs. Laser arterial and venous anastomoses are attractive because of their simplicity and rapidity of performance. Their patency is comparable to sutured anastomoses, but arterial aneurysms remain a hazard despite use of extremely low laser energy.
激光辅助的动脉和静脉吻合术目前已切实可行。使用显微镜引导的二氧化碳激光，以60至100毫瓦的功率对44条兔颈动脉（直径1.5至2.0毫米）和27条兔腔静脉（直径4至6毫米）进行端端吻合。将这些结果与采用间断缝合技术修复的对照动脉进行比较。在术后24小时至19周期间对吻合口进行检查。激光颈动脉吻合术的通畅率为93%（44条中的41条），动脉瘤发生率为9%（44条中的4条），而手工缝合的颈动脉吻合术通畅率为91%（44条中的40条），且无动脉瘤形成。在腔静脉方面，27例激光吻合中有26例通畅（96%），而20例缝合对照中有19例通畅（95%）。27例激光吻合中有2例（7%）出现静脉瘤样扩张，20例手工缝合吻合中有3例（15%）出现。激光辅助吻合术的组织学检查显示局部全层热损伤。修复过程是通过成纤维细胞和肌成纤维细胞增殖实现的，在激光修复和缝合修复中，管腔细胞覆盖在14天时均已完成。激光动脉和静脉吻合术因其操作简单快捷而颇具吸引力。它们的通畅率与缝合吻合术相当，但尽管使用了极低的激光能量，动脉动脉瘤仍然是一个风险因素。
