美国访学见闻和对我国光/激光医学人才培养的思考

目的通过赴美国访学考察和文献调研,对国内外光/激光医学人才培养的现状和经验进行分析,以期为我国光/激光医学人才培养提供初步参考。方法笔者2016年赴哈佛医学院和麻省总医院Wellman光医学中心访学,在进行科研与临床学习的同时,对美国光医学人才培养、临床执业准入和继续教育制度等进行了考察。结合对近30年国内外相关文献的调研以及专家访谈,对我国光/激光医学人才培养的现状进行了分析。在此基础上,对我国光/激光医学人才培养提出建议。结果美国的光医学人才培养、临床执业准入与继续教育方面均有严格的政策法规和认证制度,管理体系较完善。这为有效帮助从业人员保持临床知识和技能的更新提供了保障。我国虽然有些临床治疗技术已走在了世界的前列,但由于没有光/激光医学临床执业准入制度、人员构成多元化、水平层次不一、缺乏规范培训等原因,出现了一些不利于学科健康发展的问题。作者建议在加强基础教育的同时,逐步完善和提升光/激光医学继续教育与管理体系和专业化水平,并加速光/激光医学复合型人才培养。结论光/激光医学作为一个新兴临床医学学科,其人才的培养方式需要高瞻远瞩的顶层设计、规范严格的制度体系和系统完善的培养机制,更...     

Percutaneous transluminal laser angioplasty. Progress over the past two years

The progress in percutaneous transluminal laser angioplasty (PTLA) over the past two years is presented. The technical development includes the application of new equipments to laser sources, delivery systems and monitors. We review new experimental research in rapidly establishing animal models and human postmortem specimens, as well as efforts to select adequate wave length and irradiation time for laser energy with suitable infusion media. A summary of clinical trials is given on expanding usage, complication rates and long-term patency of PTLA. The current trends in PTLA respecting guide wire assisted balloon angioplasty and other recanalization methods are described.     

Laser Therapy in Lumbar Herniated Discs

The results of experimental and clinical studies using different laser systems in intradiscal blind and endoscopic/foraminoscopic lumbar disc operations are described. We describe the evolution from blind intradiscal techniques starting in 1989 to current endoscopic/foraminoscopic procedures in 1997. Lasers are important and useful tools in these procedures.     

Magnetic Catheter Manipulation in the Interventional MR Imaging Environment

PurposeTo evaluate deflection capability of a prototype endovascular catheter, which is remotely magnetically steerable, for use in the interventional magnetic resonance (MR) imaging environment.Materials and MethodsCopper coils were mounted on the tips of commercially available 2.3–3.0-F microcatheters. The coils were fabricated in a novel manner by plasma vapor deposition of a copper layer followed by laser lithography of the layer into coils. Orthogonal helical (ie, solenoid) and saddle-shaped (ie, Helmholtz) coils were mounted on a single catheter tip. Microcatheters were tested in water bath phantoms in a 1.5-T clinical MR scanner, with variable simultaneous currents applied to the coils. Catheter tip deflection was imaged in the axial plane by using a “real-time” steady-state free precession MR imaging sequence. Degree of deflection and catheter tip orientation were measured for each current application.ResultsThe catheter tip was clearly visible in the longitudinal and axial planes. Magnetic field artifacts were visible when the orthogonal coils at the catheter tip were energized. Variable amounts of current applied to a single coil demonstrated consistent catheter deflection in all water bath experiments. Changing current polarity reversed the observed direction of deflection, whereas current applied to two different coils resulted in deflection represented by the composite vector of individual coil activations. Microcatheter navigation through the vascular phantom was successful through control of applied current to one or more coils.ConclusionsControlled catheter deflection is possible with laser lithographed multiaxis coil-tipped catheters in the MR imaging environment.     

近10年低强度激光照射治疗压疮的临床研究综述

通过检索中国知网(中国知识基础设施工程,China National Knowledge Infrastructure,CNKI)数据库、维普中文科技期刊数据库(VIP China Science and Technology Journal Database,VIP)、PubMed数据库,筛选后最终获得近10年低强度激光照射治疗压疮的临床研究文献19篇,其中中文17篇,英文2篇。临床常用于压疮照射治疗的低强度激光主要有半导体激光、He-Ne激光。激光照射治疗压疮的疗效与压疮的分期以及激光的参数相关,对Ⅰ期压疮效果最好,且与激光疗效密切相关的参数主要是波长和能量密度。现对近10年低强度激光照射治疗压疮的临床研究进行综述。     

准分子激光血管成形术的动物实验和临床应用

为实现利用国产激光器施行血管成形术的愿望，利用３０８ｎｍＸｅＣｌ准分子激光器消融活体兔髂动脉粥样硬化斑块及活体狗股动脉血栓。兔狭窄病变动脉１５条，成功率９３％；闭塞动脉１９条，成功率８９％；狗血栓动脉２０条，成功率８５％。１９９２年用同类激光器治愈一例老年妇女的髂动脉上段阻塞。证实用国产器件配合紫外光纤耦合系统进行准分子激光血管成形术的临床应用是可行的。     

The development of a distribution system for medical lasers and its clinical application

We developed a new laser beam generator system which can deliver laser beam to multiple terminals in distant clinical therapy rooms. The system possesses the distribution equipment by which Nd-YAG laser power is distributed to 8 output terminals under the computer control. Distributed laser beam is delivered to each distant terminal with clinical informations through the optical fiber. In the fundamental studies, possibility of distant transportation of laser beam (30 m) only with 10% loss of energy and without dangerous heating at the connection parts was shown. There seems to be no disadvantage associated with distribution laser beam. In the clinical study, the system was applied to five patients with the symptoms including hemosputum, esophageal stenosis, hemorrhage, lip ulcer and pain. Clinical usefulness of the system was proved. The advantages of the system are as follows: 1. Benefit of cost reduction due to multiple use of single laser source. 2. No necessity of transport of the equipment. 3. No requirement of a wide space to install the equipment in the distant room. 4. Efficient management and maintenance of the system by centralization. Further improvements, e.g., simultaneous use at multiple terminals and elongation of transportation up to 340 m, make the system more useful for clinical application.     

595nm脉冲染料激光联合点阵式Er：YAG激光治疗酒渣鼻的临床疗效

目的探讨595nm脉冲染料激光联合点阵式Er：YAG激光治疗酒渣鼻的疗效及安全性。方法酒渣鼻患者27例，以595nm脉冲染料激光照射病变区，2周后再以点阵式Er：YAG激光治疗病变区。两次治疗为一个疗程，共治疗4个疗程，分别于末次治疗后2周和6个月观察疗效。结果末次治疗后2周显效率为92．6％，治疗后6个月显效率为88．9％；患者满意率达85．2％。结论595nm脉冲染料激光联合点阵式Er：YAG激光治疗酒渣鼻安全有效。     

点阵CO2激光结合湿性医疗技术治疗增生性瘢痕的临床效果观察

目的 观察点阵CO2激光结合湿性医疗技术治疗增生性瘢痕的临床疗效并总结临床经验.方法 点阵CO2激光结合湿性医疗技术治疗不同原因所致的增生性瘢痕,根据评定标准对治疗结果进行评价.结果 点阵CO2激光结合湿性医疗技术治疗增生性瘢痕的显效率为84.69％,总有效率为100.00％.结论 点阵CO2激光结合湿性医疗技术治疗增生性瘢痕疗效确切,该技术值得临床推广.     

美容激光治疗后皮肤修复新途径——皮肤原位再生复原技术

基于热效应原理的美容激光技术,通过光热作用、选择性光热作用或局灶性光热作用,达到微创治疗皮肤色素性疾病、血管性疾病以及去除瘢痕,皮肤年轻化等疗效,但会形成不同程度的烧伤或热损伤创面,无法避免术后出现色素异常或瘢痕的可能.临床实践发现,联合应用MEBT/ MEBO 技术通常可以使微创创面达到相对无瘢痕愈合的原位再生修复效果,缩短了创面愈合时间、减少了微创治疗次数、降低了瘢痕形成和色素异常的风险、减少了治疗成本.MEBT/ MEBO 是一项非常适合在整形美容领域应用的新型治疗技术.     

Analog image recording using a laser printer and paper system

This article describes a method for generating gray scale analog hard copy images on ordinary paper using a laser printer system. Operation of the computer-controlled laser printer is described. The cost of the laser printer/paper technology is estimated and compared with the cost of multiformat camera/conventional film systems. Results of an initial clinical evaluation of laser printed paper images are presented.     

1470nm激光的临床应用进展

随着激光医学的发展,半导体激光器目前在临床中应用广泛。新型激光1 470 nm半导体激光的能量即可被血红蛋白吸收也可被水吸收,与绿激光、YAG激光、CO₂激光、940 nm激光等传统激光比较,具有较强的组织吸收率、较高的切割效率和较低的能量消耗,目前在肿瘤切除、美容医学、微创手术中应用广泛。本文就波长1 470 nm激光在临床各学科中的应用做一综述。     

早期激光干预在预防手术后瘢痕中的临床应用进展

随着激光医学的发展,近年来激光在瘢痕的防治中取得了一定的效果。早期激光干预,已逐渐应用于预防手术后瘢痕形成。本文就早期(术后3个月内)激光干预手术后瘢痕形成的理论基础、激光类型的选择及其临床应用进行简要综述。     

Potentials of a new laser guidance system for percutaneous musculoskeletal procedures

 Early experience using a new laser guidance device to assist CT-guided percutaneous musculoskeletal procedures is presented. We describe six cases, which demonstrate typical musculoskeletal applications of laser guidance. In our experience laser guidance for these procedures resulted in improved accuracy with no significant increase in biopsy time when a short learning period is considered. Other musculoskeletal procedures may benefit from laser guidance in preference to current standard CT-guided techniques, particularly when precision and accuracy are essential.     

钬激光治疗多发性表浅膀胱肿瘤

目的 探讨钬激光治疗多发性表浅膀胱肿瘤的临床效果.方法 对43例多发性表浅膀胱肿瘤进行钬激光治疗,激光能量1.0～1.4 J,功率10～14 W,频率10 Hz.术后配合化疗药物或卡介苗灌注,观察其疗效.结果 41例应用钬激光将肿瘤顺利切除,2例改行开放手术.操作时间20～160 min,平均55 min.术后对38例进行了随访,随访时间6～24个月,3例复发.结论 钬激光治疗多发性表浅膀胱肿瘤操作较简单、对病人损伤小、疗效可靠.     

Laser-assisted chondroplasty

Laser-assisted chondroplasty is a controversial issue in arthroscopy. Some preliminary research has demonstrated that laser energy can stimulate DNA synthesis and matrix production in articular cartilage. Other studies cite the dangers of thermal energy with laser use on articular cartilage. Commonly used lasers and their current research are discussed in this chapter. It is unclear whether or not the laser will remain in the arthroscopists' arsenal for chondroplasty, and further research is warranted.     

Nd：YAG激光联合C02激光与常规手术治疗阴道残端息肉的疗效比较

目的比较Nd：YAG激光联合CO：激光与常规手术治疗阴道残端息肉的疗效。方法阴道残端息肉患者284例,随机分成激光组142例和对照组142例。激光组采用Nd-YAG激光联合CO：激光治疗,对照组行常规的阴道残端息肉摘除术＋阴道填塞治疗,比较两组的治疗效果。结果激光组不需住院,医疗费用、术中出血量、手术时间、术后伤口愈合时间显著低于对照组（P〈0．001）,术后复发率为7．04％显著低于对照组的34．5％（P〈0．01）。结论激光治疗阴道残端息肉操作简便、费用低、费时少、伤口愈合快、复发率低,是目前治疗阴道残端息肉的理想治疗方法。     

Potentials of laser guidance system for percutaneous musculoskeletal procedures

 Early experience using a new laser guidance device to assist CT-guided percutaneous musculoskeletal procedures is presented. We describe six cases which demonstrate typical musculoskeletal applications of laser guidance. In our experience laser guidance for these procedures resulted in improved accuracy with no significant increase in biopsy time when a short learning period is considered. Other musculoskeletal procedures may benefit from laser guidance compared with current standard CT-guided techniques, particularly when precision and accuracy are essential.     

激光气化减压术加臭氧联合脊柱调衡手法治疗腰椎间盘突出症的疗效分析

目的探讨激光气化减压术加臭氧联合脊柱调衡手法治疗腰椎间盘突出症的临床疗效。方法腰椎间盘突出症患者147例,分为：治疗组（A组）患者73例,采用激光气化减压术加臭氧联合脊柱调衡手法治疗;对照组（B组）患者74例,采用激光气化减压术联合臭氧注射治疗。术后1、3和6个月随访,根据M~nab标准进行疗效判定,比较两组患者术后疗效。结果两组患者手术成功率100．0％。A组术后1、3和6个月有效率分别为65．8％、74．0％、80．8％;B组术后1、3和6个月有效率分别为43．2％、47．3％、48．6％,两组患者疗效比较差异有显著意义（P〈0．05）。结论激光气化减压术加臭氧联合脊柱调衡手法治疗腰椎间盘突出症的临床疗效显著,是一种中西医结合治疗腰椎间盘突出症的新思路、新方法。     

Infrapopliteal and below-knee popliteal lesions: treatment with sole laser thermal angioplasty. Work in progress

Laser-assisted balloon angioplasty has been successfully performed in peripheral and coronary arteries; however, the ability to perform laser angioplasty alone without the need for subsequent balloon angioplasty has not been reported. In the present series, infrapopliteal and below-knee popliteal sole laser thermal angioplasty was successfully performed on 14 of 16 (88%) lesions in 10 patients. Initial clinical and hemodynamic improvement was observed in seven of 10 (70%) patients, with clinical failure noted in three nonsurgical candidates with poor distal vessel runoff. Short-term clinical follow-up (mean, 6 months) revealed 100% patency at the site of laser thermal angioplasty. Clinical success was maintained in five of seven (71%) patients; symptoms recurred in two patients who had undergone laser thermal angioplasty and adjuvant balloon angioplasty of superficial femoral artery lesions. Treatment of distal peripheral arterial lesions with laser thermal angioplasty alone is feasible; studies comparing it with conventional balloon angioplasty should be considered.