Fischer D W, Beggs J L, Shetter A G, Waggener J D
Neurosurgery. 1983 Sep;13(3):287-94. doi: 10.1227/00006123-198309000-00013.
Recent reports have suggested that peripheral neurectomy with the CO2 laser may be effective in preventing subsequent neuroma formation. To study this question further, we performed bilateral sciatic nerve sections in 31 rats using a steel scalpel on one nerve and a CO2 laser on the opposite side. The animals were killed 30 days after neurectomy and specimens were removed for gross observation, light microscopy, and electron microscopy. Axon composition studies were carried out in selected animals and axon diameter histograms were prepared. Well-formed neuromas were present in nerves transected by both the scalpel and the CO2 laser. The scalpel neuromas were characterized by a greater degree of interfascicular collagen deposition and perineurial cell proliferation. Laser neuromas demonstrated less perineurial compartmentalization and scar tissue formation. In addition, a foreign body reaction with multinucleated giant cells surrounding carbonaceous debris was seen that was not present in the scalpel neuromas. Analysis of axon composition studies revealed that both neuromas had a greater density of axons and a higher percentage of small diameter myelinated and unmyelinated axons as compared to control nerves. Laser neuromas had more axons per unit area than scalpel neuromas, but the percentage composition of axons was very similar in the two groups. We could find no evidence in the rat sciatic nerve model that CO2 laser neurectomy is less likely to result in neuroma formation than is conventional scalpel neurectomy.
近期报告表明，二氧化碳激光进行外周神经切除术可能对预防后续神经瘤形成有效。为进一步研究此问题，我们对31只大鼠进行双侧坐骨神经切断术，一侧神经用手术刀切断，另一侧用二氧化碳激光切断。神经切除术后30天处死动物，取出标本进行大体观察、光学显微镜检查和电子显微镜检查。对选定动物进行轴突组成研究并绘制轴突直径直方图。手术刀和二氧化碳激光切断的神经中均出现了形成良好的神经瘤。手术刀所致神经瘤的特征是束间胶原沉积程度更高和神经束膜细胞增殖。激光所致神经瘤的神经束膜分隔和瘢痕组织形成较少。此外，还观察到围绕含碳碎片有异物反应及多核巨细胞，而手术刀所致神经瘤中未出现这种情况。轴突组成研究分析显示，与对照神经相比，两种神经瘤的轴突密度均更高，小直径有髓和无髓轴突的百分比也更高。激光所致神经瘤每单位面积的轴突比手术刀所致神经瘤更多，但两组轴突的百分比组成非常相似。在大鼠坐骨神经模型中，我们没有发现证据表明二氧化碳激光神经切除术比传统手术刀神经切除术导致神经瘤形成的可能性更小。
