高功率CO_2激光心肌打孔机的研制及临床应用  

Performance Characteristics and Clinical Application of High Power CO_2 Laser

作　　者：吴明营[1] 李功宋[1] 李峻亨[2] 宋永成 朱朗标[1] 顾瑛[2] 韩继之 张仁尧[4] 余翼飞[1] 车兴平 杨泽泉[4] 

机构地区：[1]解放军总医院心血管外科,北京市100853 [2]解放军总医院激光科 [3]北京梅曼电子公司 [4]北京大学第一医院

出　　处：《中国激光医学杂志》2002年第3期166-170,共5页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的　研制用于激光心肌打孔血运重建术 (TMLR)的高功率CO2 激光治疗仪 ,并对其生物学效应及临床应用效果进行评价。方法　采用激光合成方法研制产生大功率CO2 激光的心脏打孔机 ,分别在有机玻璃块、犬离体心脏和活体心肌缺血模型上进行激光心肌打孔实验 ,以检验合成光束的的生物物理特性 ,选择安全有效的激光心肌打孔参数。在此基础上 ,使用该仪器为6 5例冠心病病人行TMLR手术并观察效果。结果　在有机玻璃和离体猪心打孔显示孔道孔径、深度可以满足TMLR的使用要求。使用该仪器在犬缺血心肌打孔形成透壁孔道 ,1周后光镜下可见孔道通畅。 6 5例接受TMLR手术患者中 ,3例分别于术后第 3天、第 4天及第 8天因呼吸衰竭、心力衰竭及心律失常死亡 ,其余病人均顺利出院 ,随访 6～ 30个月 ,5 0例患者心绞痛明显减轻 ,其中 37例较术前减少 2级 ,15例减少1级 ;7例变化不明显 ,失访 5例。 2 6例术后行心肌放射性核素断层扫描 ,有 2 1例心肌打孔区域的血液灌注比术前明显增加。结论　合成高功率CO2 心脏激光打孔机治疗仪在TMLR的动物实验及临床应用中安全有效。Objective TMLR is new treatment method for patients who suffer from coronary artery disease. Up to now TMLR development is limited in domestic hospital due to expensive cost of import device. So our first objective in this study was to develop a high powered CO 2 laser device and assess the effect of our device in the experiment. Our second objective was to evaluate the feasibility of TMLR using our device as an alternative treatment for patients unsuited for CABG. Methods A device high power CO 2 laser apparatus, which includes CO 2 laser, electric power system, articulated arm able to transmit laser beam, laser tip, control system and heartbeat monitor in order to perform transmyocardium revascularization by CO 2 laser was developed The paper includes the principle of the device, characteristic of each part of the apparatus. In order to test the effectiveness of the apparatus, some different approaches in drilling channels with CO 2 laser were undertaken in vitro and in vivo animal experimentation. Based on series of the results of experiment, TMLR was performed on the beating heart in 65 patients using HL 100 HEART LASER since Dec 1995. Follow up ranged from 6 months to 30 months. Results The experimental results showed that the characteristic of laser channels made with HL 100 HEART LASER is satisfiable to the basic requirement of TMLR. Histologic studies (microscopically) of laser treated area in dogs revealed that the lased channels of myocardium remained patent 7 days after TMLR. An average of 21±3 channels were created in patients. The mortality in hospital was 3 of 65 cases. Postoperatively, the relief of angina was noted in 50 cases following TMLR. Postoperative 99m Tc SPECT was obtained at 3, 6 or 12 months in 26 patients. 99m Tc SPECT showed a significant improvement of myocardial perfusion in 21 cases as compared with baseline. Conclusion It is sure that the CO 2 laser apparatus developed by us is able to satisfy the experimental and the clinical application of the T

关 键 词：激光心肌打孔机 研制 临床应用 激光 心肌血管重建术 治疗 TMLR 

分 类 号：R454.2[医药卫生—治疗学]