计算机扫描CO2激光美容术初探

为探讨围产计算机扫描ＣＯ２激光美容手术的方法与机理,自１９９６年１１月我们在广泛临床实践与研究基础上,对２２例面部皱纹、痤疮性瘢痕等患者进行了除皱、皮肤再生治疗,积累了一定经验。本文针对扫描ＣＯ２激光美容手术的方法、原理及术中操作问题进行了初步研讨,认为该治疗系统不失为皮科、美容外科的一项重要治疗手段,国产设备能适应临床治疗需要。     

CO_2激光治疗有碍美容皮肤病1188例分析

激光是一种高能技术，近年来发展迅速，应用范围日益广泛．作者通过ＣＯ_２激光对体表１５种，１１８８例病损的治疗，探讨了ＣＯ_２激光作用于生物体后产生的生物学效应、所致皮肤细胞变化的机理、及对热效应的强弱如何影响皮肤细胞的变化作了阐述，对ＣＯ_２激光治疗皮肤病变的方法作了介绍．本组病例采用ＣＯ_２激光，个别病例配合冷冻及其他方法治疗，治愈率９９．４９％．通过对临床资料的总结，详细论述了ＣＯ_２激光的优越性及其与医学美学的关系，为激光美容的发展提供了有益的经验．     

颜面部激光美容

颜面部激光美容刘，易阳艳，黄敏娜，范燕文采用激光美容法治疗颜面部各种痣，斑、疣等，具有操作简便、手术精确度高、创面小而不易出血、不需缝合、不易感染等优点，已被国内外美容学者广泛运用。近两年来，我们采用ＣＯ２及Ｎｄ：ＹＡＧ激光器治疗１８６２例，病灶５５...     

超脉冲CO_2激光在眼袋整复中的应用

我院自１９９６年５月至１９９７年１０月采取单一超脉冲ＣＯ２激光或ＣＯ２激光与手术联合行眼袋整复术２９８例。其中对１１０例皮肤无松弛或轻微松弛者采用下睑结膜经路单独激光法，而另１８８例皮肤松弛明显，眼轮匝机松弛或肥大者则采用ＣＯ２激光与手术联合治疗，采用皮肤经路法。结果２９８例均取得了满意治疗效果。手术时间短，术中术后无出血，恢复快，无一例发生色素沉着及眼睑外翻等并发症，病人乐意接受。此方法较单纯手术方法有明显优越性，值得推广。     

激光治疗酒渣鼻疗效探讨

目的：探讨ＣＯ２激光及氦氖激光治疗酒渣鼻的效果。方法：分别采用ＣＯ２激光及氦氖激光器,对６５例不同期的酒渣鼻进行治疗,其中４２例采用ＣＯ２激光,２３例采用氦氖激光治疗,治疗均采用点状照射。结果：ＣＯ２激光治疗的３０例红斑期酒渣鼻红斑和毛细血管扩张减少或消失,１２例丘疹和鼻赘期患者其症状减少或消失。氦氖激光治疗的２３例中,症状均改善,总有效率达到１００％。结论：激光点状照射可以减少疤痕产生,两种激光     

激光与手术切除治疗睑黄瘤疗效评价

目的：为了提高睑黄瘤治疗后的美容效果。方法：对１８例睑黄瘤患者进行了手术切除联合重睑术，并与接受ＣＯ２激光治疗的１６例患者作了对照，结果：手术治疗Ⅰ、Ⅱ级痊冷静之和为８８．９％（Ｐ〈０．００１），术后感染率为５．５％（Ｐ〈０．０１）。平均治愈时间为８天，结论：手术切除联合重睑术治疗睑黄瘤比用激光治疗更具有美容效果。     

超脉冲CO2激光行下睑皮肤剥脱后的组织学观察

从 1999年 5月起 ,使用国产超脉冲二氧化碳激光机 (武汉兴华 )对 16例 32侧下睑皮肤进行剥脱 ,剥脱采用 10个不同等级的能量输出 ,35 0～ 75 0ｍＪ ,每隔 40ｍＪ为一个能量等级。激光作用于皮肤后分别在 4个时间段 ,作用后即刻、0 .5ｈ、1ｈ、2 .5ｈ切取激光剥脱后的皮肤做肉眼外观检查 ,显微、超微结构检查 ,观察激光作用后该部皮肤的组织结构改变 ,探索适宜的国产超脉冲ＣＯ2 激光对国人下睑皮肤的作用能量和作用的脉冲周期。一、设备和取材使用武汉兴华光电工程有限公司生产的ＸＨ ＣＯ2 2 0 0 0超脉冲激光美容治疗机。 (激光源 :ＣＯ2 …     

超脉冲CO2激光在经结膜下眼袋整形术中的应用

目的：应用超脉冲ＣＯ２激光施行经结膜眼袋整形术。方法：术中设定超脉冲ＣＯ２激光参数和为：脉冲能量８￣１５ｍＪ；功率３￣５Ｗ；聚焦光斑直径０．２ｍｍ。聚焦ＣＯ２激光束进行切割，散焦ＣＯ２激光束进行止血，切口不作缝合。     

Ultrapulse5000“C”激光用于眼袋成形术

目的：观察新型超脉冲ＣＯ２激光用于眼袋成形手术的结果。方法：选择脂肪疝型眼袋患者，用新型激光行结膜囊内切口眼袋成形手术。结果：眼袋成形手术共１０７例，均一次手术成功，获得满意的效果。结论：超脉冲ＣＯ２激光用于眼袋成形术方便，快捷，出血少，周围组织热损伤小，无焦痂形成及伤口延迟愈合等并发症，具有普通手术中传统激光不可比拟的优点。     

CO＿2激光治疗皮肤囊肿

ＣＯ＿２激光治疗皮肤囊肿平凉侨联激光医疗中心美容整形外科（７４４０００）崔维春１９８６年以来，我科采用ＣＯ２激光治疗皮肤囊肿１８０例，取得了良好的治疗与美容效果，现报告如下：１一般资料：男１５２例，女２８例。年龄３～６０岁。其中毛鞘囊肿（皮脂囊肿）１...     

Registration using three-dimensional laser surface scanning for navigation in oral and craniomaxillofacial surgery

INTRODUCTION: Recent innovations in laser scanning technology provide a potentially useful tool for three-dimensional surface registration for image-guided surgery. The purpose of this study is to evaluate the clinical reliability of this technique in oral and maxillofacial surgical procedures using image-guided navigation. METHODS: In an experimental step, a stable anthropomorphic skull model with prelabeled markers was scanned and registered with laser surface scanning (z-touch, BrainLAB) and marker- based algorithms. The registration protocol was then repeated 25-times. Root mean square error (RMSE) and target difference values were compared for their suitability for this application. Twelve patients with different indications for oral and maxillofacial surgery were planned for image-guided surgery using a passive infrared surgical navigation system (VectorVision, BrainLAB). Preoperative computed tomography (CT) scans were carried out with newest 16-line multisclice CT-scanner (Siemens Somatom Sensation 16). The new markerless laser surface scanning technique was applied in all intraoperative patient registrations. Registration error was noted. The clinical application accuracy was determined for anatomical landmark localization deviation. RESULTS: In the experimental protocol a mean registration error (RMSE) or target difference of 1.3 (0.14) or 2.08 (0.49) mm for laser scanning and 0.38 (0.01) or 0.99 (0.15) mm for marker registration was found. The differences for RMSE and target localization were statistically significant (p < 0.005). Furthermore, a strong correlation between RMSE and target difference was found for laser scanning (r = 0.96) and marker registration (r = 0.95). During various clinical procedures involving oral and maxillofacial surgery, the overall error of the registration procedure determined as RMSE was 1.21 (0.34) mm. Intraoperatively, the mean clinical application accuracy was found to be 1.8 (0.5) mm. CONCLUSION: Three-dimensional laser surface scanning technique may be a interesting and useful approach to register the patient for image-guided procedures, particularly during oral and craniomaxillofacial surgery.     

Residual Thermal Damage Resulting from Pulsed and Scanned Resurfacing Lasers

BACKGROUND: Laser resurfacing with rapidly scanned or pulsed carbon dioxide (CO2) lasers has evolved rapidly in recent years. These lasers vaporize small amounts of tissue, while leaving minimal residual thermal damage. OBJECTIVE: To compare the depth of residual thermal damage of two of the most commonly used CO2 laser systems. A rapidly scanned laser was compared to a short-pulse laser system. METHODS: Laser treatment was performed on abdominoplasty specimens prior to removal in four subjects. One, two, or three passes of the two most commonly used energies were administered using each laser system. RESULTS: The depth of thermal damage increased with a greater number of passes with each laser system. Higher energies resulted in greater residual thermal damage with each system after the first pass up to three passes, which was the maximum number of passes administered. Combining the second and third passes, residual thermal damage was remarkably similar when comparing the pulsed and scanned lasers. CONCLUSIONS: The most commonly used energy settings of two lasers with very different modes of action resulted in remarkably similar depths of thermal damage, suggesting that the zone of thermal damage may correlate with clinical outcome. In addition, the zone of thermal damage enlarges as the number of passes increases from one to three.     

Analysis of ghost cells in calcifying cystic odontogenic tumors by confocal laser scanning microscopy.

OBJECTIVE: The confocal laser scanning microscope represents an effective tool for studying biological samples stained for fluorescence observation. In this study we have used the confocal microscope to analyze ghost cells in calcifying cystic odontogenic tumors. STUDY DESIGN: Specimens from 15 calcifying cystic odontogenic tumor cases were stained with hematoxylin and eosin, and scanned by a confocal laser scanning microscope to generate optically sectioned images. RESULTS: All of the analyzed samples presented autofluorescent cells that were identified as ghost cells. The degree of autofluorescence intensity was variable and may be a result of the presence of hard keratin. CONCLUSION: The confocal laser scanning microscope may be of help in analyzing and defining the nature and extent of keratinization processes in calcifying cystic odontogenic tumor ghost cells.     

点阵铒激光治疗面部各种瘢痕的疗效及影响因素分析

目的:观察应用点阵铒激光治疗面部各种瘢痕的疗效,并对影响疗效的各种因素进行分析。方法:应用点阵铒激光对132例面部瘢痕患者皮损进行磨削、大范围平扫,分析对比依据不同影响因素分组后各组显效率差异,探索对治疗效果有影响的相关因素。结果:所有患者治疗后随访6个月,有效率97.8%,显效率85.7%,无严重不良反应。患者病史长短、皮损的临床分型、病损程度各组显效率差异有统计学意义(P<0.05),性别等其他因素对疗效无影响。结论:点阵铒激光治疗面部瘢痕疗效好,不良反应小,皮损稳定后及早治疗预后较好,皮损程度轻者预后较好,不同临床分型治疗效果不同。     

Initial clinical experience with a modified excimer laser for coronary angioplasty

A clinical study was conducted in 32 patients to evaluate the efficacy and safety of a modified excimer laser system for percutaneous transluminal coronary angioplasty. In this system, the laser beam is scanned and transmitted into eight fibre bundles of the catheter device, consisting of 20 50 μm fibres, each. Twenty-eight patients were treated with 1.5 mm laser catheters, four patients with 1.8 mm laser catheters. Mean time of energy delivery was 82±39 s using a mean energy fluence of 49±2 mJ mm⁻². In all 32 patients in whom laser angioplasty was attempted, laser irradiation resulted in a stenosis reduction from 85±10% (mean±s.d.) before to 57±20% after laser treatment. In 16 patients, additional balloon angioplasty had to be performed, either due to an insufficient angiographic result in 11 patients or due to abrupt vessel closure in five patients. In these 16 patients, percent stenosis decreased after balloon angioplasty to 35±14%, corresponding to a luminal diameter of 1.6±0.5 mm. In 10 patients, dissection was observed. In one of these patients, the dissection resulted in a reduction in antegrade flow, necessitating balloon dilatation. One perforation occurred which did not require surgery. There were no deaths, bypass surgery or myocardial infarction. During the time of follow-up, restenosis occurred in 14 patients; in two of these patients bypass surgery was performed and five patients were treated with conventional balloon angioplasty. These results suggest that this form of modified excimer energy delivery provides effective therapy for patients with coronary artery disease. Due to the small catheter sizes, however, one-half of the patients still required additional balloon dilatation. To increase the number of stand-alone laser procedures and to address the issue of restenosis in this patient population appropriately, larger catheter devices will be necessary.     

Carbon dioxide laser ablation with immediate autografting in a full-thickness porcine burn model.

OBJECTIVE: To compare the long-term clinical and histologic outcome of immediate autografting of full-thickness burn wounds ablated with a high-power continuous-wave CO2 laser to sharply débrided wounds in a porcine model. SUMMARY BACKGROUND DATA: Continuous-wave CO2 lasers have performed poorly as tools for burn excision because the large amount of thermal damage to viable subeschar tissues precluded successful autografting. However, a new technique, in which a high-power laser is rapidly scanned over the eschar, results in eschar vaporization without significant damage to underlying viable tissues, allowing successful immediate autografting. METHODS: Full-thickness paravertebral burn wounds measuring 36 cm2 were created on 11 farm swine. Wounds were ablated to adipose tissue 48 hours later using either a surgical blade or a 150-Watt continuous-wave CO2 laser deflected by an x-y galvanometric scanner that translated the beam over the tissue surface, removing 200 microm of tissue per scan. Both sites were immediately autografted and serially evaluated clinically and histologically for 180 days. RESULTS: The laser-treated sites were nearly bloodless. The mean residual thermal damage was 0.18+/-0.05 mm. The mean graft take was 96+/-11% in manual sites and 93+/-8% in laser sites. On postoperative day 7, the thickness of granulation tissue at the graft-wound bed interface was greater in laser-debrided sites. By postoperative day 180, the manual and laser sites were histologically identical. Vancouver scar assessment revealed no differences in scarring at postoperative day 180. CONCLUSIONS: Long-term scarring, based on Vancouver scar assessments and histologic evaluation, was equivalent at 6 months in laser-ablated and sharply excised sites. Should this technology become practical, the potential clinical implications include a reduction in surgical blood loss without sacrifice of immediate engraftment rates or long-term outcome.     

1.5 T magnetic resonance imaging generates accurate 3D proximal femoral models: Surgical planning implications for femoroacetabular impingement

The objective of this study was to validate three-dimensional (3D) proximal femoral surface models generated from a 1.5 T magnetic resonance imaging (MRI) by comparing these 3D models to those derived from the clinical “gold standard” of computed tomography (CT) scan and to ground-truth surface models obtained by laser scans (LSs) of the excised femurs. Four intact bilateral cadaveric pelvis specimens underwent CT and MRI scans and 3D surface models were generated. Six femurs were extracted from these specimens, and the overlying soft tissues were removed. The extracted femurs were then laser scanned to produce a ground-truth surface model. A 3D-3D registration method was used to compare the signed and absolute surface-to-surface distances between the 3D models. Absolute agreement was evaluated using a 95% confidence interval (CI) derived from the precision of the LS ground-truth. Paired samples t tests and Kolmogrov–Smirnov tests were performed to compare the differences between the signed and absolute surface-to-surface distances between the models. The average signed surface-to-surface distances for the MRI vs LS and MRI vs CT models were 0.07 and 0.16 mm, respectively. These differences fell within the 95% CI of ±0.20 mm indicating absolute agreement between the surface models generated from these modalities. The signed surface-to-surface distance was significantly smaller for MRI vs LS ground truth model as compared with the CT vs LS model. Femoral models derived from a 1.5 T MRI scan demonstrated absolute agreement with the clinical gold standard of CT-derived models and were most like LS ground truth models of the excised femurs.     

Intraoperative assessment of colonic perfusion using scanning laser Doppler flowmetry during colonic resection

BACKGROUND: Ischemia occurring on mobilization and mesenteric division is thought to be a major factor in the etiology of anastomotic dehiscence after colorectal resection. This study assessed the ability of the new technique of scanning laser Doppler flowmetry to measure changes in human colonic perfusion during mobilization at and adjacent to the anastomotic site. STUDY DESIGN: Colonic perfusion was measured in 10 patients undergoing large-bowel resection by making laser Doppler scans of the proximal bowel before mobilization, after mobilization and mesenteric division, and after resection of the specimen. Mean perfusion was calculated within 1-cm2 regions of interest, each of which contained 1,750 individual measurements of perfusion. These regions represented the anastomosis site and adjacent areas 1 cm and 2 cm proximal and distal to this. The results were expressed as mean perfusion units (PUs). RESULTS: After mobilization, there were significant decreases in perfusion in all the subjects between each time point and in all areas of the colon scanned. Median perfusion at the anastomosis site was 491 PUs before mobilization, and this fell to 212 PUs after mobilization, representing a decrease of 57%; the median within-person decrease was also 57% (p < 0.01). There was a gradient of reduced perfusion between the area 2 cm proximal to the mesenteric division (median within-person fall 25%; p < 0.05) and the area 2 cm distal to the mesenteric division (median within-person fall 84%; p < 0.01). After resection of the specimen, perfusion increased slightly at the anastomosis site to a median of 240 PUs (median within-person fall 41%; p < 0.01), but 2 cm proximal to this, median perfusion remained depressed at 330 PUs. CONCLUSIONS: This new technique can be used intraoperatively and appears to overcome the limitations of single-point laser Doppler flowmetry. In this small preliminary study, it measured large decreases in colonic perfusion during mobilization, and it may have widespread clinical applications.     

便携式高精度三维扫描仪在瘢痕量化评估中的应用——附10例瘢痕疙瘩临床报告

目的 探讨便携式高精度三维扫描仪在瘢痕量化评估中的应用前景和可行性。方法 2015年4月至11月,随机选取10名瘢痕疙瘩患者,运用便携式高精度三维扫描仪对其病灶进行扫描,对瘢痕疙瘩的相关属性进行定量检测及分析,并将结果与手工测量数据进行相关性分析与差异分析。结果 三维扫描的瘢痕长宽数据与手工测量数据相关性显著;手工测量值与3D扫描值存在显著差异(P<0.05)。结论 便携式高精度三维扫描仪能通过三维重建显示瘢痕外观特征,并有效进行定量分析,有望应用于瘢痕的诊断和疗效评估中。     

跟腱区动脉血供的三维可视化研究

目的通过数字化技术构建跟腱区动脉血供的三维可视化图像,研究跟腱区的动脉血供。方法新鲜人小腿标本三只,用30％明胶、10％朱砂、10％淀粉按比例配制的灌注液灌注,冷藏后CT扫描获得DICOM格式数据,Mimics 10．01软件处理。结果获得小腿跟腱区皮肤、骨骼、动脉、跟腱的三维可视化图像。结论跟腱区三维可视化图像可为临床提供形态学资料,虚拟手术有助于最佳手术方案的选择。