Effects of 532 nm pulsed-KTP laser parameters on vessel ablation in the avian chorioallantoic membrane: Implications for vocal fold mucosa
Effects of 532 nm pulsed-KTP laser parameters on vessel ablation in the avian chorioallantoic membrane: Implications for vocal fold mucosa
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DOI：
10.1097/mlg.0b013e31802b5c1c
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发表时间：
2007-02-01
期刊：
影响因子：
2.6
通讯作者：
Zeitels, Steven M.
中科院分区：
文献类型：
--
作者：
Broadhurst, Matthew S.;Akst, Lee M.;Zeitels, Steven M.
目标.使用针对血红蛋白的脉冲激光进行选择性血管消融（光血管溶解）是许多声带病变的有效治疗策略。然而，血管破裂伴血液外渗降低了对血管的选择性，这在0.45-ms、585-nm脉冲染料激光器中经常观察到。先前的研究表明，血管破裂是血液汽化的结果，这是一种随激光脉冲宽度和脉冲通量（单位面积能量）而变化的事件。使用532 nm波长脉冲磷酸钛钾（KTP）激光的临床观察显示，激光诱导的出血比脉冲染料激光少。本研究调查了脉冲KTP激光的设置，以实现选择性血管破坏，而不破裂，使用禽绒毛尿囊膜在类似于临床实践中的激光的柔性喉镜输送条件。研究设计.鸡胚绒毛尿囊膜为许多小血管提供了方便的通路，这些小血管的大小与人类声带中的靶血管相似。使用532 nm脉冲KTP激光器，改变脉冲宽度、脉冲能量和距光学递送纤维的工作距离，以评估对实现血管凝固而不使血管壁破裂的能力的影响。方法.对三级血管（n=135）进行辐照：系统地改变能量（471-550 mJ）、脉冲宽度（10、15、30 ms）和纤维-组织距离（1 mm、3 mm）。结果如下：增加脉冲宽度、增加纤维到组织的距离和降低能量更常实现无血管壁破裂的选择性血管破坏。使用15-或30-ms的脉冲，纤维到组织的距离为3 mm（脉冲能量密度为13-16 J/cm（2）），可持续实现血管破坏而不破裂。结论：本研究证实了我们的临床观察，即532-mn脉冲KTP激光可有效消融微循环，同时最大限度地减少血管壁破裂和出血。
Objectives. Selective vascular ablation (photoangiolysis) using pulsed lasers that target hemoglobin is an effective treatment strategy for many vocal fold lesions. However, vessel rupture with extravasation of blood reduces selectivity for vessels, which is frequently observed with the 0.45-ms, 585-nm pulsed dye laser. Previous studies have shown that vessel rupture is the result of vaporization of blood, an event that varies with laser pulse width and pulse fluence (energy per unit area). Clinical observations using a 532-nm wavelength pulsed potassium-titanylphosphate (KTP) laser revealed less laser-induced hemorrhage than the pulsed dye laser. This study investigated settings for the pulsed KTP laser to achieve selective vessel destruction without rupture using the avian chorioallantoic membrane under conditions similar to flexible laryngoscopic delivery of the laser in clinical practice. Study Design. The chick chorioallantoic membrane offers convenient access to many small blood vessels similar in size to those targeted in human vocal fold. Using a 532-nm pulsed KTP laser, pulse width, pulse energy, and working distance from the optical delivery fiber were varied to assess influence on the ability to achieve vessel coagulation without vessel wall rupture. Methods. Third-order vessels (n=135) were irradiated: Energy (471-550 mJ), pulse width (10, 15,30 ms), and fiber-to-tissue distance (1 mm, 3 mm) were varied systematically. Results: Selective vessel destruction without vessel wall rupture was more often achieved by increasing pulse width, increasing the fiber-to-tissue distance, and decreasing energy. Vessel destruction without rupture was consistently achieved using 15- or 30-ms pulses with a fiber-to-tissue distance of 3 mm (pulse fluence of 13-16 J/cm(2)). Conclusions: This study substantiates our clinical observation that a 532-mn pulsed KTP laser was effective for ablating microcirculation while minimizing vessel wall rupture and hemorrhage.