Trickett I, Dawes J M, Knowles D S, Lanzetta M, Owen E R
Microsearch Foundation of Australia, Macquarie University Sydney, NSW, Australia.
Int Surg. 1997 Jan-Mar;82(1):38-41.
This study investigated the potential of sutureless nerve repair using two promising laser fusion methods: direct 2 microns irradiation of the epineurium, and protein solder assisted epineurial fusion using a 800 nm laser.
Laser anastomosis of the rat sciatic nerve was performed in vitro without stay sutures in two groups of six animals. In the first group, direct laser fusion used a pulsed Cr, Tm: YAG laser. In the second group an albumin-based fluid solder containing the dye indocyanine green was applied to the epineurium, then irradiated with a diode laser. These two techniques were compared with regards to coaptation success and axonal damage.
Direct laser welding produced weak bonds despite microscopic investigation of the irradiated nerves showing fusion of the epineurium. The unsatisfactory bonding can be attributed to poor tissue overlap and insufficient protein in the thin epineurium denaturation of underlying axons was also observed. In contrast, the laser solder method produced successful welds with greatly reduced axonal damage, and significantly improved the tensile strength.
This study confirmed the technical possibilities of sutureless nerve anastomosis. Laser activated solders enable stronger bonds, by the addition of protein to the anastomosis site, and less thermal damage to underlying tissue through selective absorption of laser energy by dye in the solder. Further in vivo studies are required before drawing final conclusions.
本研究使用两种有前景的激光融合方法，即直接对神经外膜进行2微米激光照射和使用800纳米激光辅助蛋白质焊接进行神经外膜融合，来研究无缝合神经修复的潜力。
在体外对两组各6只大鼠的坐骨神经进行激光吻合，不使用定位缝线。第一组采用脉冲Cr, Tm: YAG激光进行直接激光融合。第二组将含有吲哚菁绿染料的白蛋白基液体焊料应用于神经外膜，然后用二极管激光照射。对这两种技术在吻合成功率和轴突损伤方面进行了比较。
尽管对照射后的神经进行显微镜检查显示神经外膜融合，但直接激光焊接产生的结合力较弱。结合效果不理想可归因于组织重叠不佳以及薄神经外膜中蛋白质不足，同时还观察到下层轴突变性。相比之下，激光焊接法产生了成功的焊接，轴突损伤大大减少，拉伸强度显著提高。
本研究证实了无缝合神经吻合术的技术可能性。激光激活焊料通过在吻合部位添加蛋白质实现更强的结合，并通过焊料中的染料对激光能量的选择性吸收减少对下层组织的热损伤。在得出最终结论之前，还需要进一步的体内研究。
