Kirsch A J, Miller M I, Hensle T W, Chang D T, Shabsigh R, Olsson C A, Connor J P
Department of Urology, Squier Urological Clinic, Columbia University College of Physicians & Surgeons, New York, New York, USA.
Urology. 1995 Aug;46(2):261-6. doi: 10.1016/s0090-4295(99)80206-4.
Laser tissue soldering (LTS) in the urinary tract provides an immediate leak-free seal and may avoid complications seen with conventional repair (such as fistula and stricture). We have begun a Phase I clinical trial investigating the use of LTS in performing urologic reconstructive surgery.
Ten patients (aged 3 months to 38 years) underwent urologic reconstruction using LTS with a protein solder composed of human albumin (42%) and indocyanine green dye. In each case standard microsuture repair preceded laser-soldered suture line reinforcement. Anastomotic closure time and immediate leak pressure were measured. Postoperatively, all patients were evaluated for evidence of complications, including stricture, fistula formation, or impaired healing.
Using LTS as an adjunct to suturing added an average of 7.9 +/- 3.0 minutes (28%) to the overall mean anastomotic time of 28.3 +/- 9.4 minutes. Intraoperative leak pressure measurements for laser-soldered anastomoses (> or = 94.2 +/- 24.2 mm Hg) were significantly higher (P < 0.001) than primarily sutured anastomoses (20 +/- 2.9 mm Hg). Two instances of suture disruption (20%) occurred during laser activation, neither of which were repaired with sutures. Average follow-up for all patients was 7.1 + - 2.2 months. There were no intraoperative or postoperative complications, including the 2 patients with suture disruption.
These initial clinical results indicate that LTS is safe, easy to perform, and, contrary to conventional suturing, provides an immediate leak-free closure. Follow-up in these and other patients, as well as those undergoing sutureless and stent-free procedures, will determine whether our method of LTS benefits patients undergoing urologic reconstruction.
尿路激光组织焊接（LTS）可实现即时无渗漏密封，且可能避免传统修复方法出现的并发症（如瘘管和狭窄）。我们已开展一项I期临床试验，研究LTS在泌尿外科重建手术中的应用。
10例患者（年龄3个月至38岁）接受了LTS泌尿外科重建手术，使用由人白蛋白（42%）和吲哚菁绿染料组成的蛋白焊料。每例患者在激光焊接缝线加固之前均先进行标准显微缝合修复。测量吻合口关闭时间和即时渗漏压力。术后，对所有患者进行并发症评估，包括狭窄、瘘管形成或愈合受损。
使用LTS辅助缝合使总体平均吻合时间（28.3±9.4分钟）平均增加了7.9±3.0分钟（28%）。激光焊接吻合口的术中渗漏压力测量值（≥94.2±24.2毫米汞柱）显著高于单纯缝合的吻合口（20±2.9毫米汞柱）（P<0.001）。激光激活过程中发生了2例缝线断裂（20%），均未用缝线修复。所有患者的平均随访时间为7.1±2.2个月。没有发生术中或术后并发症，包括2例缝线断裂的患者。
这些初步临床结果表明，LTS安全、易于操作，与传统缝合相反，可实现即时无渗漏闭合。对这些患者以及其他患者，以及那些接受无缝合和无支架手术的患者进行随访，将确定我们的LTS方法是否对接受泌尿外科重建手术的患者有益。
