Kirsch A J, Canning D A, Zderic S A, Hensle T W, Duckett J W
Division of Pediatric Urology, University of Pennsylvania, Philadelphia, USA.
Tech Urol. 1997 Summer;3(2):108-13.
Investigators have attempted sutureless surgery to decrease operative time, lessen the inflammatory response, maintain luminal continuity, and increase the ease of performing technically difficult surgery. Only recently has laser-tissue welding (LTW) been used for urologic reconstruction in humans. Herein, we present our technique of laser soldering with the half-watt diode laser and wavelength matched albumin-based solder. Our methodology of LTW relies on bonding between the outer surface of the wound edges and the solder. The 808-nm diode wavelength does not penetrate deep tissue, and thus relies on indocyanine green dye to localize photon absorption. Since 1994, we have performed LTW, as an adjunct to suturing (N = 25) and as a primary means of tissue closure (N = 11). Preoperative diagnoses included hypospadias, urethral stricture, urethral diverticulum, and urethral fistulae. Follow-up ranged between 3 months and 3 years to identify complications of wound healing, stricture, and fistula formation. In the 37 patients undergoing urethral surgery, no strictures or diverticula have resulted. None of the patients have had wound infections or poor wound healing. Overall, five patients have developed fistulas between 2 weeks and 6 months postoperatively. The location of the hypospadiac meatus was scrotal or penoscrotal in four of these patients. Two fistulas developed following sutureless urethroplasty (reoperative) after traumatic catheterization for urinary retention (one case for inadvertent catheter removal). In our initial experience, the overall complication rate using laser soldering was 19% compared to 24% in an historical control group. Half of the complications occurred in a reoperative situation. More recently, the overall fistula rate was 14%; however, for primary cases, the current fistula rate is only 6%. LTW is safe and easy to perform. The application of protein solders (+/-chromophores) have permitted far greater tensile strengths to be achieved than laser alone. Temperature-control and chromophore-control have permitted safety and efficacy to be achieved. Solder application site and technique are equally important in the success of the LTW process. A randomized, prospective study comparing LTW to suturing is ongoing.
研究人员尝试进行无缝合手术以缩短手术时间、减轻炎症反应、保持管腔连续性，并提高进行技术难度大的手术的便利性。直到最近，激光组织焊接（LTW）才用于人类泌尿外科重建手术。在此，我们介绍使用半瓦二极管激光和波长匹配的基于白蛋白的焊料进行激光焊接的技术。我们的LTW方法依赖于伤口边缘外表面与焊料之间的结合。808纳米二极管波长不会穿透深层组织，因此依赖吲哚菁绿染料来定位光子吸收。自1994年以来，我们已将LTW作为缝合的辅助手段（N = 25）以及作为组织闭合的主要方法（N = 11）。术前诊断包括尿道下裂、尿道狭窄、尿道憩室和尿道瘘。随访时间为3个月至3年，以确定伤口愈合、狭窄和瘘管形成的并发症。在37例接受尿道手术的患者中，未出现狭窄或憩室。所有患者均未发生伤口感染或伤口愈合不良。总体而言，5例患者在术后2周内至6个月出现瘘管。其中4例患者尿道下裂尿道口位于阴囊或阴茎阴囊部。2例瘘管发生在因尿潴留进行创伤性导尿后（1例因不慎拔除导尿管）行无缝合尿道成形术（再次手术）之后。在我们的初步经验中，使用激光焊接的总体并发症发生率为19%，而历史对照组为24%。一半的并发症发生在再次手术的情况下。最近，总体瘘管发生率为14%；然而，对于初次手术病例，目前的瘘管发生率仅为6%。LTW安全且易于操作。蛋白质焊料（±发色团）的应用比单独使用激光能实现更大的拉伸强度。温度控制和发色团控制实现了安全性和有效性。焊料的应用部位和技术对LTW过程的成功同样重要。一项比较LTW与缝合的随机前瞻性研究正在进行中。
