输精管内氩离子激光凝堵绝育术的动物实验与临床应用研究

为了寻找一种效果可靠,操作方法简便,并发症少,有利于推广的节育方法,我们探索应用光导纤维把氩离子(Ar~ )激光引导至动物输精管腔进行照射凝堵,以达到节育目的。选用171-09型Ar~ 激光器为激光光源,大鼠(Wistar品系,45只)、家兔(哈白兔10只)为动物模型,将光导纤维直接刺入输精管腔,Ar~ 激光输出功率为 800 mW,照射时间为 4秒。实验结果示,有效率为95％～98.8％。通过对实验结果分析、手术方法探讨认为,该方法安全可靠、实用性强、手术并发症发生率极低等优点,可推广应用。     

高功率YAG激光输精管凝堵法研究

选用20条薪鲜离体家兔输精管,用高功率NdYAG激光机,将光纤插入输精管腔内,以35～45 W 6种不同功率/时间凝堵试验.病理检查确定有效凝堵阈值为40 W/0.5～1 s.继而对150只家兔进行输精管穿刺激光凝堵试验.功率40 W组术后7～14 d为脱落组织阻塞,30 d炎性细胞增生,3月时管腔完全闭塞,呈3 mm小结节,病检为纤维组织增生,管周血管无病理损伤.作者认为用高功率NdYAG激光瞬间照射法,亦可用于输精管凝堵术,且具有效果确切,处理时间短等优点.     

激光输精管凝堵绝育术的实验研究

我们应用光导纤维把氩离子(Ａｒ )激光引导至动物输精管腔内进行照射凝堵,以探索男性节育方法。1.材料与方法:选用17109型Ａｒ 激光器(美国优尼克公司生产)为激光光源,光导纤维直径400μｍ。Ｗｉｓｔａｒ大鼠45只、哈白兔10只为动物模型,戊巴比妥钠为麻醉剂。大鼠腹腔内注射戊巴比妥钠(40ｍｇ/ｋｇ)全麻,切开阴囊皮肤,暴露并分离出左侧输精管。用光导纤维在距附睾尾约30ｍｍ处向附睾端方向穿刺输精管,调Ａｒ 激光器输出功率为800ｍＷ,照射时间为4秒,对输精管管腔进行照射。右侧输精管激光照射同左侧。分3批共照射90侧输精管。兔组采用戊巴比…     

经皮穿刺输精管氩离子激光凝堵绝育术58例操作体会

我们通过经皮穿刺的方法,用光导纤维把低功率氩离子(Ar )激光引导至输精管腔中进行照射,使其凝固,通过瘢痕组织增生阻塞输精管以达到绝育目的。共对58例男性进行了照射,现将操作体会总结如下。材料与方法一、研究对象58例凝堵对象年龄在29岁～40岁,身体健康,已婚并生有2个以上的健康子女,自愿要求行输精管绝育术。术前征得受术者同意并签署知情同意书,行     

用低功率CO_2激光行小血管吻合

作者采用新CO_2激光装置的波长研制了较手术缝合法更为简便迅速且可对外径更小的血管进行吻合的低功率CO_2激光装置,用以施行小血管吻合术。10.6μm,功率为10～125mW,光斑直径0.2mm以下,焦距127mm。发射端为固定式,可装配Zeiss OPM1～6手术显微镜。本组小血管吻合的照射条件调整到照射功率为21～40mW,照射时间为5～15秒后,行下述吻合实验。     

输精管激光节育法研究

1996年 2月以来 ,用自制的Ｎｄ∶ＹＡＧ便携式激光节育仪 ,激光源Ｎｄ∶ＹＡＧ ,波长 10 6 0ｎｍ ,裸露光纤直径 0 .6ｍｍ。输精管穿刺用套管针 (2 0Ｇ)。以兔离体输精管小段 12 0段、活兔健康兔 15 0只、人离体输精管 5 4小段为材料。方法 :(1)将光纤直接插入兔离体输精管小段     

450 nm蓝激光静态作用于猪膀胱壁组织的生物效应

目的 研究450 nm蓝激光静态作用于猪膀胱壁组织产生的生物效应。方法 以离体猪膀胱为实验材料,采用450 nm蓝激光在不同功率、作用距离和作用时间条件下作用于膀胱组织后,以肉眼、显微镜两种方式观察、记录并分析其生物学效应。结果 450 nm蓝激光作用于膀胱组织,在不同参数条件下效应不同。在短时间(1s)作用情况下,膀胱组织只表现出了凝固效应;延长作用时间、调高作用功率,膀胱组织产生了明显汽化作用,然而凝固效应不明显;在功率为5～30 W范围内,汽化深度、宽度随作用时间(2～10 s)、距离远近(0～2 mm)改变分别是汽化深度1.3～8.85 mm和1.1～2.56 mm。在功率为20 W,照射距离为0 mm、照射时间为5 s条件下,厚度为7.75 mm的膀胱组织被击穿。结论 450 nm蓝激光对猪膀胱壁组织的作用呈现良好的量效关系。蓝激光-组织汽化凝固效果与激光对组织的作用功率、作用时间成正相关,与作用距离成负相关。如需凝固止血,可以增加作用距离、延长作用时间。但需要警惕的是在零距离接触、20～30 W高功率作用时,可能造成膀胱穿孔。     

输精管激光凝堵绝育术临床应用研究

目的探索氩离子(Ar^ )激光凝堵人类输精管的作用机制,观察临床应用效果。方法62名成年已婚且有2—3个子女的健康男性志愿者为研究对象,采用Ar^ 激光照射的方法进行输精管凝堵。对前4例受试对象切开阴囊皮肤,直视下进行激光照射,其余58例受试对象经皮穿刺进行体内照射。通过精液化验,观察精子减少速度及消失时间。结果60例受试对象被照射6个月后精子数减为0,2例因照射剂量不足而失败。结论Ar^ 激光是用于输精管凝堵的较为理想的光源之一,能较好地凝堵输精管且基本无并发症和后遗症。     

输精管激光节育法实验及临床观察

目的 探讨NdYAG激光输精管节育的效果及安全性.方法 用自制的NdYAG激光节育机,对150只兔施行了输精管激光照射堵塞试验,并对953例输精管激光节育者的效果和安全性进行了跟踪观察.结果 兔(40Wx1S)秒组达到阈损伤,该组存活兔输精管堵塞率100%;人精子消失率99.4%.结论 NdYAG激光输精管节育法安全可靠,避免了开放手术并发症,为男性提供了一种可供选择的非手术节育新方法.     

氦氖激光治疗仪光导纤维调节固定器的制作与应用

临床上氦氖激光常用于眼、鼻或外耳道的炎症治疗.治疗时一般均由患者自持光导纤维照射.眼部炎症患者因需闭眼,则必须由护士或家属手持光导纤维照射,每次照射时间为15～20 min,手因无固定的支点而容易晃动,且易致手部酸软.鉴此,笔者设计制作了氦氖激光治疗仪光导纤维调节固定器,经临床应用500例,效果满意,介绍如下.     

Vasovasostomy in the murine vas deferens: comparison of the Nd:YAG laser at 1.06 microns and 1.318 microns to the CO2 laser

A comparison is made of laser anastomoses of the murine vas deferens at different energies with the neodymium (Nd):YAG laser at 1.06 micron and 1.318 micron and with the CO2 laser. A total of 28 welds were performed with a free-hand technique employing a 600-micron silicon fiber with the Nd:YAG and a hand piece with a 500-micron spot size for the CO2. After 6 weeks, all animals were sacrificed and the vasa evaluated for patency. Fifteen out of 28 controls repaired with microsurgical techniques were found to be patent; 4/10 vasa were patent with use of the Nd:YAG at 1.318 micron at laser energies of 300 mW and 500 mW. At 1.06 micron, only 1/4 anastomoses was patent at a power setting of 1 W. None of the anastomoses performed with the CO2 laser was patent. Histologic study revealed intense fibrosis in all the lasered vasa, with sperm granuloma formation associated with most anastomoses. Although this is a preliminary study, it appears that the Nd:YAG laser at 1.318 micron and a power setting of 300-500 mW provides patency rates superior to the Nd:YAG at 1.06 micron and to the CO2 lasers and is equivalent to standard micro-surgical techniques in the murine vas deferens.     

Histological study of vas deferens following intravasal laser irradiation

Aim: To study the histologic changes of the vas deferens following Nd: YAG laser irradiation. Methods:Intravasal laser irradiation was given to (i) 52 segments of rabbit (laser dosage: 2 seconds at 40W～50W) and 16 segments of human (3 seconds at 45W～55W) vas deferens in vitro, (ii) 25 rabbit vasa (2 seconds～2.5 seconds at 40W～45W) in vivo and (iii) 2 human vasa (3 seconds at 55W) in vivo. Segments of vasa were removed from the in vivo irradiated vasa deferentia 15 days ～ 180 days (rabbit) or 15 days (man) after the exposure. All vas segments were embedded in methacrylate resin. Serial sections (thickness 25μm～30μm) were obtained and observed under a light microscope. Results: (i) Laser-induced damage reached the muscularis layer in 27% and 94% of the rabbit and human vas segments in vitro, respectively. (ii) Fourteen of the 25 in vivo rabbit vasa were completely occluded by fibrous tissue and the longer the time interval after treatment, the more likely was the vas occluded. Those unoccluded vasa had either a normal histology or a mucosal damage. (iii) One in vivo human vas was almost completely occluded by the fibrous tissue but the other had a relatively large lumen packed with sperm granulomatous tissue and partial destruction of the smooth muscle layer. Conclusion: Laser irradiation can induce long-term vas occlusion; for rapid occlusion, laser doses just completely destroying the mucosal layer will be advisable.     

High intensity focused ultrasound ablation of the vas deferens in a canine model

PURPOSE: High intensity focused ultrasound is an ablative technology capable of producing thermal coagulative necrosis of sub-surface structures without injuring intervening tissues. We assessed the feasibility of using high intensity focused ultrasound to produce occlusion of the canine vas deferens. MATERIALS AND METHODS: A high intensity focused ultrasound transducer was incorporated into a hand held clip specially designed to grasp the vas deferens transcutaneously. Slots within the jaws of the clip ensured that the vas deferens and high intensity focused ultrasound target zone were properly co-located. We ablated 10 vasa using a range of power and time parameters. At 2 weeks after ablation each vas, epididymis and testis was surgically harvested en bloc. Retrograde vasography was performed to assess vasal occlusion, followed by pathological analysis. RESULTS: High intensity focused ultrasound occlusion of the vas deferens was confirmed in 4 specimens ablated with parameters at the upper end of the parameter range, 2 of the 2 ablated with 7 W. for 60 seconds and 2 of the 4 ablated with 7 W. for 30 seconds. Histological injury was noted in 8 of the 10 ablated specimens. Skin burns that developed over 4 of the targeted vasa were conservatively managed. Bilateral sham procedures in a control dog resulted in patent vasa and no associated skin burns. CONCLUSIONS: We demonstrated the feasibility of noninvasive, transcutaneous high intensity focused ultrasound occlusion of the vas deferens with ablation powers at the upper end of the tested range, that is 7 W. Modifications of the hand held clip and optimization of ablation parameters would likely improve the success rate of this procedure. Refinement of this technology may provide a rapid noninvasive alternative to conventional vasectomy.     

Effect of CO2 milliwatt laser on peripheral nerves: Part I. A dose-response study

In order to explore further the role of laser for microneural repair, the effect of CO₂ laser irradiation on intact rat sciatic nerves was investigated. In total 40 rat sciatic nerves were exposed to 12 different combinations of laser power (50, 100, and 150 mW) and pulse duration (0.1 to 3 s) normally used for CO₂ laser-assisted nerve repair. The results were evaluated 24 hr after surgery with functional toe-spreading test and light microscopy. Irradiations of 50 and 100 mW for up to 1 s exposure time per pulse resulted in almost no deficit in motor function, while 100 mW power with prolonged exposure times and 150 mW power resulted in a significant decrease in motor function. Light microscopy showed significant focal injury to the epi/perineurium and the subepineunal nerve fibres proportional to the laser energy applied to the nerve, consisting of Wallerian degeneration and thrombosis of blood vessels. In conclusion, a power of 50–100 mW in combination with a pulse duration of 0.1–1 s produced no or minimal thermal damage with no or a negligible loss of motor function. Therefore, combinations of power and pulse duration above these thresholds are considered less suitable for CO₂ laser nerve repair. MICROSURGERY 17:562–567 1996 © 1997 Wiley-Liss, Inc.     

The evaluation of sympathetic system-related contractile activity of the rat vas deferens after ligation and intra-abdominal placement of the testis.

OBJECTIVE: To evaluate the contractile response of the vas deferens in a model of stress, to determine any changes in sympathetic activity as a result of stress in the ipsilateral testis, which decreases blood flow to the contralateral testis. MATERIALS AND METHODS: The study comprised two groups of six rats each; group 1 underwent a sham operation, and in group 2 the right testis was placed into the abdominal cavity and the vas deferens ligated. After 30 days, the vasa deferentia were resected bilaterally and their isometric contractions recorded. Electrical-field stimulation (EFS) was applied through a pair of platinum electrodes and concentration-response curves constructed for noradrenaline at 37 degrees C and to a solution containing 80 mmol/L K+. RESULTS: The vasa deferentia in both groups showed similar contractile responses to EFS, which were frequency-dependent and maximal at 80 Hz. Noradrenaline-induced contractile activity was lower in amplitude in the vasa deferentia of group 2 than in the contralateral and ipsilateral vasa deferentia of group 1, which were not significantly different from each other. All groups responded similarly to high K+. CONCLUSION: Intra-abdominal placement of the testes with vas deferens ligation decreased the contractile response to noradrenaline in the ipsilateral vas deferens without altering the contractile response to EFS and high K+. This difference could be caused by a reduction in the number of postjunctional alpha-adrenergic receptors or decreased receptor sensitivity. Both possibilities suggest that the vas deferens may initiate sympathetic activity, which may be responsible for contralateral testicular deterioration.     

Effect of thyroxine on the contractile responses of the vas deferens to prostaglandin E2

The effects of prostaglandin E2 (PGE2) on the contractile activity of thyroidectomized and thyroxine-treated albino rats were studied in vitro. Thyroidectomy totally inhibited the contractile response of the vas deferens to PGE2. Thyroxine treatment, on the other hand, significantly (P < .001) potentiated the response of vasa deferentia to PGE2, when compared to controls. It is suggested that thyroid hormones play a role in the contractile response of the vas deferens to PGE2.     

输精管行程的解剖学研究及临床应用

目的:为输精管外科、尤其是长段输精管丢失再通提供解剖学基础。方法:观察18具成人尸体的输精管行程,测量各段输精管的长度及输精管末端至外环的距离。结果:输精管从外环经内环到壶腹,行程中绕了个大弯。使输精管从外环穿出,消除该弯曲,可缩短输精管6.1~12.9(9.31±1.30)cm。输精管各段的长度分别为:附睾段3.2~5.6(4.53±0.79)cm,阴囊段4.5~9.5(7.31±1.78)cm,腹股沟段4.4~7.5(5.52±0.74)cm,后腹膜段12.5~19.5(16.75±1.87)cm,壶腹段2.9~3.8(3.63±0.23)cm。输精管长度、各段长度、两侧对比差异无显着性。结论:①游离输精管使之直接从外环穿出可缩短输精管行程6.1~12.9(9.31±1.30)cm,这是长段输精管丢失缩短行程再通的解剖学基础。②两侧输精管各段及总长差异无显著性。③输精管的外科手术与各段位置密切相关。     

Early microrecanalization of vas deferens following biodegradable graft implantation in bilaterally vasectomized rats

We evaluated a biodegradable graft for reconstruction of rat vasa deferentia with long obstructed or missing segments. A total of 47 Sprague-Dawley rats underwent bilateral vasectomy and were divided into groups according to length of the vas deferens affected （0.5, 1, 1.5 cm）. After 8 weeks, poly-（D,L-lactide） （PDLA） grafts were used to reconnect the vas deferens, Grafts and adjoining vasa deferentia were excised 8 and 12 weeks later and evaluated microscopically. At 8 weeks, microscopic changes included a robust inflammatory response around the grafts. All grafts were still intact but in the early stages of degradation. No microtubules, indicative of vas deferens recanalization, were identified. One specimen showed evidence of healing and neovascularization at the interface zone between the vas deferens and the graft. At 12 weeks, grafts were further degraded but still present. Microscopic evaluation showed decreased inflammation. Seven specimens showed neovascularization at the interface zone; two of these showed distinct epithelialized vas deferens microcanals at the graft edges. One specimen showed a microcanal spanning the entire 0.5-cm graft. A time period of 8 weeks is not ample enough for vas deferens regeneration in the setting of a biodegradable PDLA graft; however, early evidence of re-growth was seen at 12 weeks. A longer healing time should permit further biodegradation of the graft, as well as re-growth and possible eventual reconnection of the vas deferens, allowing passage of sperm. These findings suggest a potential role for biodegradable grafts in the reconstruction ofvas deferens with long obstructed segments.     

CO2 and argon laser vascular welding: acute histologic and thermodynamic comparison

CO2 and argon lasers have been used successfully for vascular welding in both experimental and clinical settings. This study compared the thermodynamics during CO2 and argon laser welding of 1-cm longitudinal arteriotomies in a canine model. Continuous recordings using an AGA 782 digital thermographic system with spatial and thermal resolution of +/-0.2 mm and +/-0.2 degree C, respectively, were analyzed. A HGM argon laser using a 300-microns optic fiber held at 1 cm from the vessel edges (spot diameter = 2.8 mm) with concomitant room temperature saline irrigation (1 drop/sec) was used for argon welds. Total exposure time was 150 sec/cm. CO2 welds were performed with a Sharplan CO2 laser (spot diameter = 0.22 mm) with no irrigation for total exposure time of 10 sec/cm. Thermodynamic results and laser parameters are summarized as follows: Argon-n = 20; power = 500 mW; energy fluence = 1,400 J/cm2; Tmax = 48.8 degrees C; T mean +/- S.D. = 45.1 +/- 2.7 degrees C; CO2-n = 20; power = 150 mW; energy fluence = 3,000 J/cm2; Tmax 84.0 degrees C; T mean +/- S.D. = 60.7 +/- 9.8 degrees C. There was a significant difference (P less than .05) in thermal measurements between successful CO2 and argon vascular welds. Temperature rise during the argon welds was limited by saline irrigation. In contrast, during CO2 laser welding, the temperature rose quickly to its maximum and was maintained at a relatively high level as the laser progressed (0.1 cm/sec) along the anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)