摘要
目的初步探讨半导体激光治疗下肢静脉曲张的作用机制。方法不同试验条件下观察和比较激光对静脉壁的生物学效应，进行病理学检验；检测静脉腔内激光治疗后患者在1、3、5、7d血凝状态变化。结果静脉腔内半导体激光治疗后静脉壁全程均可见明显碳化，局部有全层穿孔，内膜剥脱破坏，细胞轮廓丧失，纤维蛋白沉积，许多区域呈现明显的空泡和水肿，胶原纤维水肿和腊样改变，内膜局部可见凝固性坏死；在激光功率小于10w、作用介质为0．9％的氯化钠溶液时，不能引起静脉壁全层明显病理学改变；连续发射模式比脉冲发射模式引起静脉壁损伤更均匀分布于全程；静脉腔内激光治疗后血凝状态没有明显改变，D-dime在术后1、3、5d明显升高。结论静脉腔内激光治疗后作用静脉内血栓形成，但是最终闭锁静脉的主要原因是激光组织汽化作用引起静脉壁全程热损伤，导致静脉壁蛋白质或酶变性失活，破坏静脉壁结构，损伤的静脉壁纤维化修复、收缩闭合。静脉腔内激光治疗时，激光对静脉壁作用主要与功率有关，而与波长无关；功率应大于10w；治疗静脉内应充满不凝血液；连续发射模式优于脉冲发射模式。
Objective To evaluate the preliminary mechanisms of endovenous laser treatment （EVLT） for lower extremity varicose vein. Methods Laser energy was endovenously administered to observe its bio- logical effects on greater saphenous vein （GSV） segments with different conditions. Some great saphenous vein that was surgically removed after EVLT was examined by means of histopathology. Cruor status was tested after EVLT. Results Histopathologic examination found the vein wall treated by EVLT showed redde- ning, carbonization, or even perforation, denudation of the intima, loss of cellular contours, and fibrin depo- sition. Additionally, some areas showed marked vacuolization of cells or even spongiosis, swelling and waxy homogenization of collagen, focal coagulation necrosis within the intima. In saline-filled veins, EVLT-in- duced vessel wall injury was confined to the site of direct laser impact. In contrast, blood-filled veins exhibi- ted thermal damage in more remote areas including the vein wall opposite to the laser impact. D-dimer was significantly changed after EVLT. Conclusions EVUF laser induced indirect local heat injury of the inner vein wall by steam bubbles originating from boiling blood is proposed as the pathophysiological mechanism of action of EVLT. Intravascular blood plays a key role fo：r homogeneously distributed thermal damage of the in- ner vein wall during EVLT. No significant difference could be detected between the two laser wavelengths. Continuous emission mode is better than pulse emission mode.
出处
《国际外科学杂志》
2011年第12期805-808,共4页
International Journal of Surgery
关键词
激光
静脉
生物学效应
Biological effect
Laser
Veins
