Sawabata N, Iuchi K, Mori T, Nezu K, Kitamura S
Department of Surgery, National Kinki Chuo Hospital for Chest Diseases, Osaka, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Jul;46(7):587-91. doi: 10.1007/BF03217784.
Diffusely emphysematous lungs are not always effectively contracted by laser therapy; however, which type of diffuse emphysema that responds to laser therapy remains unclear. We macroscopically and histopathologically examined human lung tissue, which was resected from patients with carcinoma, after irradiation with an Nd:YAG laser. Forty-six lung lobes were irradiated with a non-contact mode Nd:YAG laser at a power setting 15 watts. Macroscopically, twenty samples of normal lungs revealed moderate contraction, fourteen samples of predominantly centrilobular diffuse emphysema showed significant contraction, and eight samples of predominantly panlobular diffuse emphysema with a slight elastic network showed slight contraction. Histopathologically, the normal lungs showed amorphous change of the collagen and severely contracted elastic fibers (amorphous degeneration) at the pleura and some parenchymal coagulation; the predominantly centrilobular diffuse emphysema showed contraction of elastic fibers and collagen (coagulative degeneration) in the pleura and adequate contraction of the elastic fibers in the parenchyma and the predominantly panlobular diffuse emphysema showed only slight coagulation of the visceral pleura and very little coagulation of the parenchyma. On ex-vivo lung, panlobular emphysema was inadequately contracted by laser therapy, due to elastic recoil. Centrilobular emphysema responded to laser treatment, due to the severe contraction of the elastic fibers.
弥漫性肺气肿并不总是能通过激光治疗有效收缩；然而，哪种类型的弥漫性肺气肿对激光治疗有反应仍不清楚。我们对从癌症患者切除的人肺组织进行了宏观和组织病理学检查，这些肺组织在接受Nd:YAG激光照射后。46个肺叶以非接触模式用功率设置为15瓦的Nd:YAG激光照射。宏观上，20个正常肺样本显示适度收缩，14个主要为小叶中心型弥漫性肺气肿的样本显示明显收缩，8个主要为全小叶型弥漫性肺气肿且弹性网络轻微的样本显示轻微收缩。组织病理学上，正常肺在胸膜处显示胶原蛋白的无定形变化和严重收缩的弹性纤维（无定形变性）以及一些实质凝固；主要为小叶中心型弥漫性肺气肿在胸膜处显示弹性纤维和胶原蛋白的收缩（凝固性变性），实质内弹性纤维有适当收缩，而主要为全小叶型弥漫性肺气肿仅显示脏层胸膜有轻微凝固，实质凝固很少。在离体肺上，由于弹性回缩，全小叶型肺气肿通过激光治疗收缩不充分。小叶中心型肺气肿对激光治疗有反应，因为弹性纤维严重收缩。
