Use of a microsecond Er:YAG laser in laryngeal surgery reduces collateral thermal injury in comparison to superpulsed CO2 laser
Use of a microsecond Er:YAG laser in laryngeal surgery reduces collateral thermal injury in comparison to superpulsed CO2 laser
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与超脉冲 CO2 激光相比，在喉部手术中使用微秒 Er:YAG 激光可减少附带热损伤
DOI：
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发表时间：
2014
影响因子：
2.6
通讯作者：
C. Dalchow
中科院分区：
文献类型：
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作者：
A. Böttcher;N. Jowett;S. Kucher;R. Reimer;U. Schumacher;R. Knecht;W. Wöllmer;A. Münscher;C. Dalchow
尽管会造成严重的热凝损伤，但二氧化碳(CO2)激光的使用被认为是早期喉癌手术的金标准。在喉部手术中使用Er：Y3+铝石榴石(Er：YAG)激光作为一种减少热组织损伤的方法，受到的关注有限。本研究的目的是比较微秒级Er：YAG激光和超脉冲CO2激光在声带切割中的热损伤程度和精确度。在光学实验室中，用Er：YAG和CO2激光切割了猪的体外声带。组织学方法测定外侧上皮热损伤区和上皮下热损伤区及切割间隙宽度。环境扫描电子显微镜(ESEM)图像检查碳化迹象。用红外热像仪(IRT)测定了Er：YAG激光切割过程中的温升。与CO_2激光相比，Er：YAGs激光切割组上皮(236.44μm)和上皮下(72.91mμm)损伤区明显减少(P<0.001)。二氧化碳(878.72μm)的切割间隙明显小于Er：Yg(1090.78μm；p=0.027)激光。ESEM显示Er：YAG激光切割边缘有完整的胶原纤维，没有明显的碳化，与CO2激光切割时看到的弥漫碳化和组织融化相比。IRT显示Er：YAG激光切割术的绝对温升低于70℃。本研究表明，与CO2激光相比，使用Er：YAG激光进行声带切开时，侧向热损伤区明显减少，底部切开间隙较宽。
Despite causing significant thermocoagulative insult, use of the carbon dioxide (CO2) laser is considered gold standard in surgery for early stage larynx carcinoma. Limited attention has been paid to the use of the erbium:yttrium–aluminium-garnet (Er:YAG) laser in laryngeal surgery as a means to reduce thermal tissue injury. The objective of this study is to compare the extent of thermal injury and precision of vocal fold incisions made using microsecond Er:YAG and superpulsed CO2 lasers. In the optics laboratory ex vivo porcine vocal folds were incised using Er:YAG and CO2 lasers. Lateral epithelial and subepithelial thermal damage zones and cutting gap widths were histologically determined. Environmental scanning electron microscopy (ESEM) images were examined for signs of carbonization. Temperature rise during Er:YAG laser incisions was determined using infrared thermography (IRT). In comparison to the CO2 laser, Er:YAG laser incisions showed significantly decreased epithelial (236.44 μm) and subepithelial (72.91 μm) damage zones (p < 0.001). Cutting gaps were significantly narrower for CO2 (878.72 μm) compared to Er:YAG (1090.78 μm; p = 0.027) laser. ESEM revealed intact collagen fibres along Er:YAG laser cutting edges without obvious carbonization, in comparison to diffuse carbonization and tissue melting seen for CO2 laser incisions. IRT demonstrated absolute temperature rise below 70 °C for Er:YAG laser incisions. This study has demonstrated significantly reduced lateral thermal damage zones with wider basal cutting gaps for vocal fold incisions made using Er:YAG laser in comparison to those made using CO2 laser.