连续Nd:YAG激光治疗皮肤血管瘤的疗效观察

目的观察连续Nd：YAG激光（1064nm）治疗皮肤血管瘤的疗效。方法根据不同血管瘤的类型。选用适当的照射功率、照射时间和照射方式。蜘蛛痣、化脓性肉芽肿和较浅的草莓状血管瘤选用扫描式照射，输出功率为15～30W，直到病灶变为灰白色或轻微凹陷；较深的海绵状血管瘤和混合型血管瘤将光纤插入瘤体内并作扇形推进照射。输出功率为30～50W，每个方向照射2～3s，直到瘤体凹陷变平。结果139例患者经过1～5次治疗后，病灶消失，无明显的瘢痕形成。其中草莓状血管瘤59例，治愈39例，有效19例，无效1例；海绵状血管瘤28例，治愈8例。有效19例，无效1例；蜘蛛痣25例，全部治愈；化脓性肉芽肿17例，全部治愈；混合型血管瘤10例，治愈1例，有效6例，无效3例。随访2年，无复发。结论连续Nd：YAG激光是治疗除鲜红斑痣外各种血管瘤的一种有效方法。     

强脉冲光及Nd:YAG(1064nm)激光治疗皮肤血管瘤疗效观察

目的:评价应用强脉冲光及Nd:YAG(1064nm)激光治疗皮肤血管瘤的临床效果。方法:回顾并随访2006年1月～2010年12月在笔者科室采用强脉冲光及Nd:YAG(1064nm)激光治疗的476例皮肤血管瘤患者,对其疗效进行分析。结果:随访2年,皮肤浅表血管瘤治愈率为88.4%,有效率为10.7%,深浅混合血管瘤联合药物注射治疗的治愈率为78.4%、有效率为17.6%,副作用轻微。结论:强脉冲光及Nd:YAG(1064nm)激光治疗皮肤血管瘤疗效好、治疗次数少、安全性高,值得推广。     

长脉冲Nd:YAG激光“点阵式”治疗面部血管瘤疗效观察

目的:探讨使用长脉冲Nd:YAG激光治疗面部血管瘤的新方法。方法:68名患儿,共68个皮损,血管瘤直径1.0～3.2cm,平均2.2cm,随机分为传统组和点阵组,将脉冲Nd:YAG激光(参数:能量密度160～220mJ/cm2,脉冲宽度15ms,光斑直径3mm)光斑分别以传统整片覆盖方式及点阵式作用于血管瘤表皮,根据表皮变化调整能量,治疗终点为每脉冲激光作用后表皮变灰白。术后予局部防水、外涂金霉素软膏处理。治疗间隔1～2个月,治疗次数3～5次。结果:两种治疗方式治疗后血管瘤都有不同程度的改善,传统组有效率为96.77%,点阵组有效率为97.30%,点阵式相比于传统方式疗效更显著(P<0.05),且点阵组出现并发症的几率较传统组少。结论:长脉冲Nd:YAG激光以点阵式治疗面部血管瘤较传统方式效果好,值得临床推广。     

手术联合Nd:YAG激光治疗弥漫性海绵状血管瘤(附87例报告)

目的:探讨弥漫性海绵状血管瘤治疗的新方法。方法:作者设计了一种治疗弥漫型海绵状血管瘤的新方法,即先以外科手术翻瓣显露血管瘤瘤体,应用Nd:YAG激光照射凝固血管瘤病灶,然后直接缝合创面。1998年1月～2003年10月,共收治87例四肢或躯干的弥漫性海绵状血管瘤病人。结果:所有病人术后无肢体功能障碍或切口大出血等并发症。随访1～63个月,经临床及影像学检查评估,达显效者71例(81.6%);有效者16例(18.4%);总有效率为100%。无血管瘤复发情况。结论:手术联合Nd:YAG激光治疗弥漫性海绵状血管瘤具有操作简便、组织损伤小、出血少、疗效确切和并发症少等优点,为本病的治疗提供了新途径。     

长脉宽1064nmNd：YAG激光治疗儿童皮肤血管瘤的疗效

目的探讨长脉宽1064nmNd：YAG激光治疗儿童皮肤血管瘤的疗效和不良反应。方法将207例血管瘤患者（164例为增生期,43例为静止期）分为两组：A组为皮损完全位于皮肤（142例）;B组为部分皮损位于皮下（65例）,使用长脉宽1064nmNd：YAG激光治疗。分别选择光斑直径2、6mm,能量50～90J／cm2和脉宽10、40、60ms进行治疗,治疗间歇期为1个月。结果207例经1～6次治疗后．两组总有效率均为100％。两组治疗有效率的差异无统计学意义（P〉0．05）。不良反应率为11．6％,均可以逐渐恢复。结论长脉宽1064nmNd：YAG激光治疗浅表型皮肤血管瘤疗效显著,不良反应少且短暂。     

Nd：YAG激光治疗腋臭64例

腋臭常常给患者带来很大的精神和心理压力。我们采用 Nd:YAG激光对 6 4例腋臭患者进行治疗 ,取得了满意的疗效。1　临床资料本组 6 4例均为我院皮肤科门诊患者 ,其中男性2 4例 ,女性 40例 ;年龄 1 4岁～ 54岁 ,有家族史者58例 ,占 90 .6 %。部分患者有外用药和冷冻等治疗史 ,效果均不理想。2　治疗方法患者仰卧 ,双上肢上抬外展 ,肘关节屈曲双手置于头部 ,尽量充分暴露腋窝 ,剃除腋毛 ,按常规消毒术区皮肤。用 2 %利多卡因 1 0 ml加生理盐水1 0 ml～ 1 5ml稀释 ,分两侧腋部作皮下浸润麻醉 ,使术区皮肤隆起 0 .5cm左右采用国产的 Nd:YAG…     

倍频Nd:YAG激光治疗酒渣鼻疗效观察

目的：研究激光治疗酒渣鼻的临床疗效。和倍频Ｎｄ：ＹＡＧ（ＶＰＷ５３２ｎｍ）激光治疗酒渣鼻,结果：此方法治疗酒渣鼻治愈率８０％。结论：倍频Ｎｄ：ＹＡＧ（ＶＰＷ５３２ｎｍ）激光是治疗酒渣鼻的有效方法之一。     

Nd:YAG激光治疗男性尖锐湿疣224例

1995年 10月～ 2 0 0 0年 5月我院应用Ｎｄ :ＹＡＧ非接触式激光治疗阴茎尖锐湿疣 (ｃｏｎｄｙｌｏｍａａｃｕｍｉ ｎａｔｕｍ ,ＣＡ) 2 2 4例 ,效果良好。1　资料和方法1 1　材料　ＢＺ ＶＩ型Ｎｄ :ＹＡＧ激光机 ,最大输出功率为 60Ｗ ,治疗阴茎ＣＡ时输出功率调为 2 0Ｗ。1 2　临床资料　阴茎ＣＡ病人 2 2 4例 ,年龄 18～ 77岁 ,病程 1周～ 4个月。ＣＡ发生于冠状沟部为 112例 ,包皮部 68例 ,尿道口 2 5例 ,多发 19例 ,均经病理检查确诊。详细记录发病部位、大小、数目。1 3　方法　禁止性生活 1个月并建议其性伴侣同时诊治。病人取平卧…     

Q开关Nd:YAG激光治疗不良眼线疗效评价

目的：评价Ｑ开关Ｎｄ：ＹＡＧ激光对不理想眼线文饰的疗效。方法：以质量分数描述疗前疗后不理想眼线文饰的表现，以积分下降比率确定疗效。结果：８２例求治者治疗前总积分（３６７分）与治疗一次后总积分（２０８分）８２例最后痊愈：２３例，显效：５１例，无效：８例。经统计学处理，差异有显著性意义（ｔ＝３．６５ Ｐ〈０．００１）。激光能量大小的选择、接受治疗次数与眼线的颜色有关。结论：Ｑ开关Ｎｄ：ＹＡＧ激光对去除     

聚桂醇硬化剂联合长脉冲1064nm Nd:YAG激光治疗婴幼儿混合型血管瘤疗效观察

目的:评价应用聚桂醇硬化剂联合长脉冲1 064nm Nd:YAG激光治疗婴幼儿混合型血管瘤的临床疗效。方法:婴幼儿混合型血管瘤患者10例,应用聚桂醇注射液局部注射并联合应用长脉冲1 064nm Nd:YAG激光,观察治疗前后皮损的变化。结果:经过6个月的随访,按照Achauer疗效评定法,在10例皮肤混合性血管瘤的婴幼儿患者中,治疗效果为IV级5例,Ⅲ级2例,II级3例,I级0例,有效率为100%。结论:聚桂醇硬化剂联合长脉冲1 064nm Nd:YAG激光对于混合型血管瘤患者具有较好的效果,并且不良反应少,可在临床推广使用。     

Effects of super-pulsed Nd-YAG laser on arterial tissue: comparison with continuous wave

The effects of a super-pulsed Nd-YAG laser at 1.32 μm wavelength on normal or atherosclerotic human arterial tissue were evaluated and compared with those obtained with continuous wave. One joule per pulse was delivered through a 0.2 mm optical fibre with a pulse width of 10 ms at 10 Hz (super-pulse), or 10 W (10 J) were delivered at continuous wave in saline or blood. Ten joules were delivered with super-pulse or continuous wave for each tissue specimen. The aortic specimens were lased either by continuous wave or super-pulse. At super-pulse mode, ablation efficiency (mm³ J⁻¹) was 0.0149±0.0044 for normal tissue in saline, 0.0148±0.0043 for atheroma in saline, 0.0138±0.0062 for normal tissue in blood, and 0.0146±0.0049 for atheroma in blood. There was no significant difference between the groups. At continuous wave mode, ablation efficiency was 0.0507±0.0299 for atheroma in blood (p<0.001 vs super-pulse). However, extensive charring was observed with continuous wave lasing (41% with continuous against 14% with pulsed mode,p<0.001). Heavily calcified plaques were also ablated at 1.5 J per pulse and 15 W (continuous wave), resulting in extensive charring with continuous wave (77% vs 18% with super-pulse,p<0.01). In conclusion, at super-pulse mode, 1.32 μm Nd-YAG laser has neither the selectivity for atheroma nor influence of blood, thermal injury induced by super-pulse is less than that induced by continuous wave (cw), calcified plaques can be ablated by super-pulse, and super-pulsed Nd-YAG laser angioplasty is safer to use than continuous wave.     

Use of the Nd-YAG laser in neurosurgery

Summary After many years of experience, in general we prefere the Nd-YAG laser, although the CO₂ laser is an advantage in a few specific cases (lipomas, cranial synostosis). While the focused CO₂ laser may be used as a cutting instrument in less vascular tissue with little trauma to the surroundings, the Nd-YAG laser produces a homogeneous coagulation with an energy dependent depth effect. Thus, with the Nd-YAG laser residual tumour tissue can be selectively and with a predictable depth effect thermally destroyed. Because of its excellent coagulation property, the use of the Nd-YAG laser is particularly indicated in highly vascular meningeal tumours. The shrinkage of a tumour and its demarcation which is due to the varying absorption properties facilitates the dissection and allows in addition the preservation of normal tissue.     

Nd-YAG laser ablation of arteriosclerotic obstructions: Clinical long-term results in femoropopliteal artery occlusions

Laser recanalization of peripheral artery occlusions was performed in 338 patients. A continuous wave Nd-YAG laser was used in combination with sapphire-probe laser catheters. The initial recanalization rate was 85%. Complications such as dissections, perforations, emboli and spasm were observed in 14%. The cumulative patency rate after 3 years was 48%.     

The role of pulse length in limiting distant damage to vascular tissue caused by the Nd-YAG laser

The total damage caused by equivalent doses of energy given to human cadaver vascular tissue over the same time scale from three Nd-YAG lasers of different pulse lengths is quantified. The continuous wave (c.w.) laser produces vacuolation and coagulation around a vaporized crater; the 100 μs pulsed laser produces less surrounding damage and the 10 ns pulsed laser none at all. The areas of damage in five craters made with 10 J energy were measured from histology slides using a digitising platten, and it was found that in each case the total amount of damage was the same, even though the depth of the craters made varied. The dose response for vaporization of the 10 ns pulsed laser was the greatest at 35 μm/J and that of the c.w. laser was least at 8 μm/J. A pulse length of 100 μs may not be the optimum for limiting surrounding tissue damage during laser angioplasty but it produces much less damage than a c.w. laser and unlike the 10 ns pulses is easily transmissible down an optical fibre.     

Percutaneous peripheral laser angioplasty with a pulsed Nd-YAG laser and sapphire tips

Percutaneous transluminal laser angioplasty with a pulsed Nd-YAG laser (1064 nm wavelength, 100s pulse duration, up to 0.4 J per pulse, 10 Hz repetition rate) coupled to optical fibres with sapphire tips of 1.8 and 2.2 mm diameter was performed under experimental conditions and then in 30 chronic occlusions of femoral and popliteal arteries in 22 patients.The experimental study in 11 human cadaverous arteries revealed that this laser system was effective in the recanalization of seven femoropopliteal occlusions, but the relative rigidity of the sapphire-tipped contact probe prevented its access to two infrapopliteal vessels. Two perforations occurred after the recanalization of 18 and 15 cm, respectively.Clinically the procedure was successful in 17 out of 25 sessions (68%). The probe formed a primary channel of at least 2.0 mm width which was further dilated by conventional balloon catheter. Ankle/brachial systolic pressure index (ABPI) increased from 0.43±0.13 to 0.79±0.21 after the procedure. In eight cases complications occurred. Two reocclusions were treated by Streptokinase infusion, two procedures were repeated 2 months later, one patient was referred to elective bypass surgery, and three patients were treated conservatively. Six patients were followed-up for more than 6 months. In one patient claudication of 400 m reappeared. ABPI showed a moderate decrease from 0.84±0.20 to 0.69±0.19.These first results are encouraging and it is likely that this method could become an important adjunct to balloon angioplasty.     

Hysteroscopic treatment of uterine bleeding with the Nd-YAG laser

This preliminary study involves 45 patients, referred to us for hysterectomy, who complained of uterine bleeding that was resistant to conventional treatment. Prior to surgery, these patients had a diagnostic hysteroscopy which showed that the bleeding was due to submucosal fibroids, to intrauterine or cervical polyps, either alone or in association with adenomyosis, or to adenomyosis alone. These patients were treated as outpatients with the Nd-YAG laser, by using paracervical anaesthesia. In 80%, the menstrual cycle has returned to normal after a short follow-up (four cycles). Three patients required hysterectomy because hysteroscopy was impossible owing to multiple fibroids. Two patients have been lost to follow-up observations. In addition, there was a beneficial result on secondary dysmenorrhoea. Wherever necessary, uterine septa and synechiae were divided. Between six and 10 weeks after treatment, a follow-up hysteroscopy was performed. This confirmed that there was no recurrence of the underlying lesion, that the treated areas were scarred and that the endometrium in these areas was functional. Longer follow-up is necessary to assess the precise proportion of hysterectomies that can be avoided by using this technique.     

A controlled trial of Nd-YAG laser vs photodynamic therapy for advanced malignant bronchial obstruction

A prospective randomized study was set up to evaluate the efficacy of photodynamic therapy (PDT) compared with Neodymium Yttrium Aluminium Garnet (Nd-YAG) laser used endoscopically in patients with stage III inoperable lung cancer and substantial (>50%) endobronchial luminal obstruction: of the 26 patients in the study 11 were allocated to Nd-YAG laser treatment (Group I) and 15 to PDT (Group II). Patients were assessed clinically, radiologically, functinally and endoscopically before and at 1 monthly intervals after treatment for 3 months, then 3 monthly when applicable. Age, sex, pulmonary function and mean percentage of bronchial luminal opening before treatment were comparable in the two groups, and not statistically different. At 1 month after treatment all patients had subjective amelioration of their symptoms and objectively responded to treatment by a substantial increase in bronchial luminal opening. There was however a significantly greater improvement in the PDT (Group II) than the Nd-YAG laser treatment Group I (p<0.0006). The bronchial disobliteration was attended by improvement in pulmonary function which again was significantly greater in Group II (PDT) than in Group I (Nd-YAG). It was concluded that endoscopic PDT in patients with extensive lung cancer and major airway obstruction is more effective than Nd-YAG laser treatment.     

Nd-YAG laser for general surgery

We report here our clinical experiences with Nd-YAG laser on general surgery, and evaluate the results of this procedure. From December 1979 to December 1981, we applied Nd-YAG laser to various operations as a hemostatic and cutting tool. For hemostasis, we used conventional quartz fiber which was covered with sterile tube, and hemostatic efficacy was examined especially in the subcutaneous bleeding and the bleeding from solid organs. For cutting, we used special devices, ie, Medilas YAG surgical probe (noncontact-type probe), and a laser blade (contact-type probe), and performed four liver resections. It is concluded that the hemostatic efficacy of Nd-YAG laser to various bleeders was proved in general surgical procedures, and furthermore this laser can cut tissue if we utilize these devices. When comparing these two devices, we would prefer the contact-type probe.     

Fibrescopic Nd-YAG laser treatment of superficial bladder tumours in outpatients

The neodymium-YAG (Nd-YAG) laser has been used via a flexible cystoscope to treat 48 superficial bladder tumours in 39 patients. The procedure can usually be performed with minimal discomfort under topical urethral anaesthesia alone or supplemented by a small dose of benzodiazepine. It is therefore suitable for use in ambulant outpatients. Local tumour clearance can be expected when this method is used. The savings in hospital admission costs and general anaesthesia may justify the comparatively high capital cost of the laser.