腹腔镜Nd: YAG激光术治疗轻度子宫内膜异位症100例分析

我们采用腹腔镜Ｎｄ：ＹＡＧ激光术治疗轻度（Ｒ－ＡＦＳＩ－Ｉ期）子宫内膜异位症（ＥＭ）患者１００例，随访１２～２４个月，９５例合并不孕症患者中除３例避孕外４４例（４８％）均在术后１年内受孕，其中３３例（７５％）在术后半年内受孕。单纯ＥＭ致不孕者７６％（１９／２５）妊娠，合并其他不孕因素者３７％（２５／６７）妊娠。自然流产７例（１６％）中４例于３个月后再次受孕，其他原因终止妊娠者３例。足月分娩３８例，新生儿无异常。７０例痛经者中，６２例症状消失，４例明显改善，４例无变化，总有效率９４％。６例曾服丹那唑或安宫黄体酮治疗６个月无效者，痛经完全缓解，其中２例妊娠。１０例再次腹腔镜检查，原有病灶完全消退，无粘连。认为，腹腔镜Ｎｄ：ＹＡＧ激光术是治疗轻度ＥＭ的有效方法。     

Treatment of wrinkles with the nonablative 1,320-nm Nd:YAG laser.

Ablative laser resurfacing with the CO2 and Er:YAG lasers has become a well-accepted and well-reported modality for skin rejuvenation of photoaged and photodamaged skin. However, the side effects associated with these lasers, such as exudation and crusting followed by prolonged erythema, are often socially disturbing for the patient. A nonablative 1,320-nm pulsed Nd:YAG system has been developed that controls dermal collagen damage while preserving the epidermis. Thirteen patients are presented on whom periocular wrinkle treatment was carried out during two sessions 1 month apart. Side effects were minimal. Histology showed improvement in the previously typical sun-damaged dermis. However, although physician assessment noted a trend toward macroscopic improvement, almost all patients failed to see any improvement. The authors conclude that further studies of the ideal parameters are required before the 1,320-nm Nd:YAG laser can be indicated successfully in stand-alone, nonablative wrinkle removal. In addition, patients should be selected carefully, and a complementary minimally aggressive technique should be used to restore a youthful appearance to the epidermis.     

倍频Nd:YAG激光治疗毛细血管扩张133例

目的:观察Versapulse可调长脉宽倍频Nd:YAG532nm激光(VPW532)治疗毛细血管扩张的疗效及安全性。方法:使用VPW532激光治疗毛细血管扩张133例,观察其疗效和不良反应。结果:133例患者中,应用VPW532激光治疗1～3次后,治愈104例,显效20例,有效9例,总有效率达93.2%。仅有6例出现暂时性色素沉着,均无瘢痕形成。结论:VPW532激光治疗毛细血管扩张疗效显著,副作用轻微。     

Nd: YAG laser iridectomies: 100 consecutive cases

We reviewed the patient charts of our first 100 consecutive Nd:YAG laser iridectomies. Our success rate (99%) is the same as that reported by others. Iris bleeding was not problematic. We did find that relative pupillary block may still be present with a patent but very small Nd:YAG iridectomy; that transillumination is not an adequate criterion for assessing patency; and that a Nd:YAG laser iridectomy, probably in part because of its small size, frequently closes with chronic inflammation.     

Q-开关Nd:YAG激光单脉冲与多脉冲治疗文身的疗效比较

目的探讨Q-开关Nd∶YAG激光单脉冲和多脉冲治疗亚洲人皮肤蓝-黑色文身的疗效差异,并明确多脉冲能否提高疗效和减少治疗次数。方法将33例蓝-黑色文身共73处随机分成单脉冲和多脉冲（双或三脉冲）治疗区,间隔6-8周以与首次相同的脉冲形式重复治疗,每次均对皮损的消退情况进行评分,并对不同脉冲治疗组皮损消退情况进行比较。结果对单脉冲治疗组和多脉冲治疗组的疗效评分,进行t检验,P〉0.05,差异无统计学意义;蓝-黑色文身经Q-开关Nd∶YAG激光单脉冲或多脉冲治疗1次后,皮损即有明显改善（31%的文身色素消退50%-74%,23%的文身色素消退75%-100%）,并随治疗次数增多,皮损改善更明显,3次治疗后,95%的文身色素消退50%以上。结论Q-开关Nd∶YAG激光去除亚洲人皮肤蓝-黑色文身安全、有效,多脉冲激光并不能提高疗效和减少治疗次数。     

Treatment of urethral syndrome: a prospective randomized study with Nd:YAG laser

INTRODUCTION: The urethral syndrome is characterized by irritative disturbances, the urgency-frequency syndrome and/or pain associated with negative urine cultures. Areas of metaplasic tissue in the trigonal-bladder neck region (trigonitis) are sometimes present. We performed a comparative randomized study to assess the efficacy of side- or end-firing neodymium (Nd):YAG laser surgery in destroying metaplasia and relieving symptoms. MATERIALS AND METHODS: Between January 1997 and December 2003, 62 consecutive women with the urethral syndrome and squamous metaplasia of the bladder neck-trigone, who were refractory to drugs, were randomly assigned to treatment with end-firing (group A) or side-firing (group B) Nd:YAG laser. Three, 6 and 12 months after surgery all patients underwent a clinical urological examination and cystoscopy. Surgery was considered successful when patients reported they were satisfied with the outcome or stated on the UDI-6 questionnaire that symptoms were reduced by at least 75%. RESULTS: Group A end-firing laser: patients rapidly improved (2-3 weeks) but symptoms worsened within 3 months. At 6-12 months, symptoms had improved in 19% of the 31 patients and remained unchanged or worsened in 81%. Group B side-firing laser: irritative disturbances worsened in the 7-10 days after therapy but markedly improved within 2-3 months. Symptoms significantly improved in 68% of the 28 patients and remained unchanged or worsened in 32%. Results were significantly better after side-firing laser (p < 0.001) and a trend towards improvements emerged as the joule levels rose. At 3 months, cystoscopy and biopsy showed squamous metaplasia was no longer present in patients whose symptoms had improved. Whitish areas were still present in the bladder neck-trigone in patients whose symptoms had remained unchanged or worsened. These patients were retreated. CONCLUSIONS: In the treatment of the urethral syndrome the few reports on attempts to restore a normal urothelium by means of diathermocoagulation and cryotherapy have been encouraging. Side-firing laser, which produces necrotic coagulation followed by reconstitution of normal functional epithelium, was significantly more successful than end-firing and was associated with a 78% success rate. These results are encouraging in patients who are usually refractory to medical therapy.     

Use of a pulsed picosecond Nd: YAG laser in 6,664 cases

We used a modulated picosecond Nd:YAG laser to perform preoperative anterior capsulotomies and posterior capsulotomies in eyes with and without an intraocular lens, and to cut a variety of cyclitic membranes, iridocapsular adhesions, and vitreous traction bands in more than 6,500 cases. The complications were transient bleeding when vascularized tissues were cut because the laser does not coagulate, temporary anterior chamber inflammation, and transient increased intraocular pressure. The last two were caused by released lens material and shock wave side effects.     

Clinical experience with the Nd:YAG laser

This study presents the results and complications of 389 patientswho were treated with the Nd:YAG laser between September 1982 and November 1983 with at least a six-month follow-up. The majority of patients had a secondary discission of the posterior capsule. Other procedures included vitreolysis, iridotomy, pupilloplasty, synechialysis, intraocular suture cutting, cutting of intraocular lens haptics, and removal of anterior pseudophakic pigmented precipitates. We have purposely avoided performing preoperative laser anterior capsulotomies and have been unsuccessful in reopening freshly sealed trabeculectomy sites. The visual acuity improved in 83.1% of patients. No statistically significant difference in visual outcome was detected in relation to the time interval between surgery and Nd:YAG laser treatment. The most common adverse finding was an increase in intraocular pressure, which occurred to some degree in 63% of patients. Rare complications included cystoid macular edema and retinal detachment. No statistical correlation between these complications and preexisting conditions or intraoperative variables could be found.     

Intraocular microsurgery with a picosecond Nd:YAG laser

We investigated the use of picosecond Nd:YAG laser pulses for intraocular microsurgery. With a pulse duration of 100 picoseconds, only 70 μJ of pulse energy is required to consistently produce optical breakdown in the deep vitreous. This pulse energy is nearly two orders of magnitude less than the typical pulse energies used in conventional (nanosecond) photodisruptors. The reduced pulse energy results in a smaller zone of tissue damage, an important consideration when operating close to the retina or other sensitive ocular structures. Efficient cutting action is achieved by applying multiple pulses at a moderately high repetition rate of 50–200 Hz. An in vitro model was developed to assess axial confinement of picosecond photodisruption. In vivo vitreous membrane surgery was performed in experimental rabbit eyes to demonstrate a potential clinical application of picosecond laser—induced optical breakdown. © 1994 Wiley-Liss, inc.     

Treatment of cutaneous and deep vascular lesions with the Nd:YAG laser

This study intends to document and evaluate the first compiled experience in the treatment of both cutaneous and deep vascular lesions using the Nd:YAG laser. Thirty-eight patients were treated over a 5-year period from 1979 to 1984 using the Nd:YAG laser with FDA approval. Lesions included capillary, cavernous, combined capillary-cavernous hemangiomas, portwine stains, arteriovenous malformations, lymphangiomas, multiple telangiectasias, and one case of Klippel-Trenaunay-Webber syndrome. The number of treatments per patient ranged from one to four. Partial or complete resolution of these various lesions, as evidenced by a decrease in size, and/or normalization of pathologic cutaneous changes was noted in a majority of patients. While both the argon and CO2 lasers have been well studied in the treatment of cutaneous vascular lesions, this is the first compiled series reporting results using the Nd:YAG for such problems. The Nd:YAG laser represents an alternative modality in the treatment of cutaneous hemangiomas and introduces an efficacious method in the treatment of cavernous vascular lesions.     

Treatment of resistant tattoos using a new generation Q-switched Nd:YAG laser: influence of beam profile and spot size on clearance success

BACKGROUND AND OBJECTIVES: Multiple treatments of resistant tattoos often result in fibrosis and visible textural changes that lessen response to subsequent treatments. The aim of this study is to evaluate the influence of beam profile and spot size on clearance rates and side effects in the setting of resistant tattoos. STUDY DESIGN/MATERIAL AND METHODS: Thirty-six professional, black tattoos (32 patients) were treated unsuccessfully with a Q-switched Nd:YAG laser (MedLite C3, HoyaConBio Inc., Fremont, CA). Because of therapy resistance all tattoos were re-treated using a new generation Nd:YAG laser (MedLite C6, HoyaConBio Inc.). Maximum energy fluence (E (max)), mean energy fluence, mean spot size, level of clearance, side effects and beam profile (irradiance distribution) of both laser systems were assessed and evaluated in a retrospective study. RESULTS: All tattoos were previously treated with the C3 laser at 1,064 nm using a mean E(max) of 5.8+/-0.8 J/cm(2) (range 3.8-7.5 J/cm(2)) as compared with a mean E(max) of 6.4+/-1.6 J/cm(2) (range 3.2-9.0 J/cm(2)) during the C6 treatment course. Corresponding spot sizes were larger during C6 treatments as compared with C3 (5.0+/-0.9 and 3.6+/-0.2 mm, respectively). The C6 laser had a "flat top" and homogenous profile regardless of the spot size. For the C3 laser the beam shape was "Gaussian," and the homogeneity was reduced by numerous micro-spikes and micro-nadirs.After the C6 treatment course 33.3% of the tattoos showed clearance of grade 1 (0-25%), 16.7% of grade 2 (26-50%), 16.7% of grade 3 (51-75%), 30.5% of grade 4 (76-95%), 2.8% of grade 5 (96-100%). The total rate of side effects due to C6 treatment was 8.3% in all tattoos (hyperpigmentation 5.6%, hypopigmentation 2.7%, textural changes/scars 0%). CONCLUSION: This clinical study documents for the first time the impact of a 1,064-nm Nd:YAG laser with a more homogenous beam profile and a larger spot size on the management of resistant tattoos. Only a few treatment sessions were necessary to achieve an additional clearance with a low rate of side effects.     

Nd:YAG laser bipolar dissector--preliminary results.

We have developed a laser bipolar dissector (LBD) which uses the 1,064 nm Nd:YAG wavelength. The laser emits from the inner surface of the distal 7 mm of each probe made of synthetic sapphire. With low laser power (15-25 W), the bipolar provides hemostatic cutting of larger blood vessels. Animal experiments were carried out using New Zealand white rabbits. The LBD hemostatically cut through veins up to 5 mm and arteries up to 2 mm in diameter. Rebleeding did not occur. Transection of parenchymal organs such as liver and lung was easily performed with complete hemostasis. In chronic experiments a partial hepatectomy with splenectomy and left nephrectomy was performed using the LBD alone without any ligation. Up to 3 weeks postoperatively there were no direct complications related to using the LBD. In conclusion the LBD could perform a hemostatic transection of large vessels and might have clinical application in the dissection of vascular parenchymal organs.     

Photodynamic therapy using pheophorbide a and Nd:YAG laser.

The authors describe a new photodynamic therapy (PDT) method for malignant brain tumors. Pheophorbide a (Ph-a), the photosensitizer, has low toxicity, causes no skin sensitization and is activated with an acoustic Q switched neodymium yttrium-argon-garnet (Nd:YAG) laser which achieves deep tissue penetration. The Ph-a distribution in Fisher 344 (F344) rats bearing rat T9 glioma at 24 hours after intravenous injection was very low in the normal brain tissue, but significantly higher in the T9 glioma giving a tumor to normal brain tissue concentration ratio of 7.5:1. The in vitro survival rate of T9 glioma cells pretreated with Ph-a was 68.8 +/- 5.4% after laser irradiation for 20 minutes, significantly lower than in the control groups. This indicates that Ph-a was activated with the acoustic Q switched Nd:YAG laser causing the photodynamic effect. The survival rate after Ph-a pretreatment and laser irradiation in a waterbath at 44.0 degrees C was further reduced to 15.8 +/- 3.3%. In vivo PDT studies using T9 glioma cells inoculated into the dorsal region of F344 rats showed tumor eradication in four of six rats. The combination of PDT and laser hyperthermia produced tumor eradication in all six rats. The combination of PDT and hyperthermia is a promising method for tumor treatment.     

Modeling of tissue heating with a pulsed Nd:YAG laser

Temperature profiles were measured in large sections of bovine muscle and bovine liver exposed to single pulses from a clinical Nd:YAG laser. The data were analyzed with a photothermal model applicable to an incident gaussian beam including the effects of beam spread and heat flow. Closed form expressions for the radial average initial temperatures and thermal relaxation were derived and compared with the measurements.     

Nd:YAG laser ablation of early pelvic endometriosis: a report of 61 cases

Sixty-one patients with mild or moderate endometriosis were treated with the Nd:YAG laser between May 1983 and March 1986. During the follow-up period, 31 patients received no supplemental medical treatment. Ten patients were given danazol, five for recurrence of pain and five because of the extent of the disease. Sixteen patients were given oral contraceptives, 12 for birth control and four for pain. Four patients received danazol plus oral contraceptives as concurrent therapy. Overall, symptoms improved following surgery for 45 patients (74%); two patients (3%) reported a worsening of symptoms, while 12 patients (20%) reported no change in their symptoms. The overall improvement rate was 65% for those receiving no hormonal treatment, 70% for those on danazol, 94% for those on oral contraceptives, and 75% for those on both contraceptives and danazol. This latter finding, however, is not significant because of the small patient sampling. Nevertheless, these findings reflect the benefit of laser ablation of early-stage pelvic endometriosis with or without the concurrent use of conservative medical therapy.     

Splenic resection with the Contact Nd:YAG laser system

Splenic resection in the dog was proven to have decreased blood loss (52%), decreased operating time (44%), and decreased surgical manipulation using the SLT Contact Nd:YAG Laser System with the synthetic sapphire probe, as compared with the noncontact CO2 laser. Tissue damage and hematologic changes were minimal and equivalent in both laser systems. The overall ease of use and operating technique was subjectively better with the contact Nd:YAG laser, and the danger of scattered and reflective beam damage was eliminated. The contact Nd:YAG laser with the synthetic sapphire probes offers a significant advantage over the noncontact CO2 laser in the resection of splenic tissue. Future applications in pediatric surgery now need to be evaluated.     

经尿道接触式激光治疗前列腺增生216例报告

目的：探讨接触式激光治疗前列腺增生症（ＢＰＨ）的有效性。方法：１９９５年７月～１９９８年７月采用ＮＤ：ＹＡＧ接触式激光治疗ＢＰＨ２１６例。激光输出功率５０Ｗ,治疗时间５～１５ｍｉｎ。结果：随访３个月～３年,２０１例一次治疗成功,１３全钎２次激光治疗,２例改行开放性手术治愈。结论：激光手术虽然不能取代开放性手术,但其具有适应证宽、安全性高、易于掌握、患者痛苦小等优点,近期疗效肯定,易被老年患者接受。