Tang J, Godlewski G, Rouy S, Dauzat M, Juan J M, Chambettaz F, Salathe R
Laboratory of Experimental Anatomy, Faculty of Medicine Montpellier Nîmes, Montpellier I University, France.
Lasers Surg Med. 1994;14(3):229-37. doi: 10.1002/lsm.1900140305.
A series of direct carotid end-to-end laser anastomosis vs. direct manual suture was carried out on a series of 70 Wistar rats (mean weight 260 g). Both common carotids (0.8-1.2 mm) were sectioned and repaired. The left side (n = 70) was submitted to laser-assisted microvascular anastomosis (LAMA) performed by means of a diode laser device (wavelength 830 nm and power output 3 W in continuous wave) without chromophore. The right side (n = 70) underwent a control manual suture (CMA). The diode laser energy was delivered into a micromanipulator coupled to a Zeiss operating microscope with a focused spot of 300 microns in diameter. After placement of three 10.0 stitches for edge coaptation, the LAMA was achieved using laser shots (average 3) of 500 mW power, 4.5 s duration, and 700 W/cm2 irradiance each. The CMA was performed by means of six 10.0 stitches. The good vascular flow was confirmed by Doppler spectral analysis (n = 466) carried out from day 0 to day 90. Light and scanning electron microscopy (n = 82) showed that re-endothelialization after LAMA was gaining ground on day 3, whereas collagenous network developed in the media scar by day 10. In contrast, after CMA the arterial repair was delayed on day 20, inducing a media fibrotic scar. The patency rate was 93% in both anastomoses. The shorter operating time (13 min for LAMA vs. 22 min for CMA) and the noncontact laser technique are the main intraoperative advantages. The technical benefits of the diode laser are pointed out.
在70只Wistar大鼠（平均体重260克）上进行了一系列颈总动脉端端激光吻合术与直接手工缝合的对比实验。将双侧颈总动脉（直径0.8 - 1.2毫米）切断并修复。左侧（n = 70）采用二极管激光装置（波长830纳米，连续波输出功率3瓦，无发色团）进行激光辅助微血管吻合术（LAMA）。右侧（n = 70）进行对照手工缝合（CMA）。二极管激光能量通过与蔡司手术显微镜耦合的微操作器传递，聚焦光斑直径为300微米。在放置三针10.0缝线进行边缘对接后，使用功率500毫瓦、持续时间4.5秒、辐照度700瓦/平方厘米的激光脉冲（平均3次）完成LAMA。CMA通过六针10.0缝线进行。从第0天到第90天通过多普勒频谱分析（n = 466）确认了良好的血管血流。光镜和扫描电镜（n = 82）显示，LAMA术后第3天再内皮化开始形成，而到第10天中膜瘢痕处形成胶原网络。相比之下，CMA术后第20天动脉修复延迟，导致中膜纤维化瘢痕。两种吻合术的通畅率均为93%。较短的手术时间（LAMA为13分钟，CMA为22分钟）和非接触激光技术是主要的术中优势。文中指出了二极管激光的技术优势。
