长脉冲激光治疗下睑静脉性黑眼圈的临床研究

目的 探讨长脉冲激光治疗下睑静脉性黑眼圈的临床疗效和安全性.方法 采用长脉冲1064nm Nd:YAG激光,光斑直径6mm,双脉宽6～10ms,脉冲间隔20ms,能量130～140J/cm2,接触式冷却治疗,治疗间隔1个月;治疗后6个月时随访,并评价病灶的清除率,共分为五级:Ⅰ级(0～24%),Ⅱ级(25%～49%),Ⅲ级(50%～74%),Ⅳ级(75%～99%),Ⅴ级(100%).结果 本组30例患者,治疗1～3次,均达到下睑静脉完全清除.获随访6个月,清除率为100%,未见复发.治疗时,患者仅有中度疼痛(评分均值为3.6分),皮肤红斑均在24h内消退,治疗部位无一例发生紫癜、色素改变和瘢痕形成.结论 长脉冲1064nm Nd:YAG激光能有效、安全地治疗黑眼圈,并能选择性地清除显露的下睑静脉,对下睑皮肤无损伤,可达到理想的美容效果.     

长脉冲Nd：YAG激光治疗龟头静脉畸形

目的评价长脉冲Nd：YAG激光治疗龟头静脉畸形的疗效及安全性。方法 10例龟头静脉畸形患者接受长脉冲1064nmNd：YAG激光治疗,7～8ms双脉宽、脉冲间隔20ms、120～140J/cm2能量密度、接触式冷却。治疗5～7次,治疗间隔1个月,疗程结束后随访12个月,观察并发症,并分五级评价病灶清除率。结果 1例患者治疗时有轻度疼痛;所有患者治疗部位均出现暂时性红斑和水肿,无出血、感染、色素改变、瘢痕形成和勃起功能障碍等。随访12个月,全部患者龟头静脉畸形病灶完全清除,未见复发。结论长脉冲Nd：YAG激光能安全有效地治疗龟头静脉畸形,并发症少,可作为龟头静脉畸形的首选治疗方法之一。     

Gentle YAG 1064nm激光治疗龟头浅表静脉畸形

目的探讨长脉冲Gentle YAG 1064 nm激光治疗龟头浅表静脉畸形的临床疗效及安全性。方法对12例经MRI确诊为浅表龟头静脉畸形患者使用长脉冲Gentle YAG 1064 nm激光进行治疗,术中动态冷却,光斑直径1.5 mm或3.0 mm,脉宽10~30 ms,能量密度180~260J/cm~2,治疗间隔1.0~1.5个月,总治疗次数2~8次。疗程结束后随访并进行医师评价、患者满意度的5级评价及并发症记录。结果疗程结束后1个月,医师根据疗效评价:5级5例,4级7例;患者满意度评价:8例非常满意,4例满意。随访3~18个月,均未见复发。1例患者于第1次治疗后轻微感染,2周后愈合,并残留浅表瘢痕;所有患者治疗后均无出血、色素改变及勃起功能障碍。结论对于浅表龟头静脉畸形应用长脉冲Gentle YAG 1064 nm激光治疗效果肯定,安全性高。     

单用强脉冲光、长脉宽Nd:YAG激光以及低能量下两者联合使用治疗微静脉畸形的临床疗效比较

目的:观察单用强脉冲光、长脉宽1064nm Nd:YAG激光以及低能量下两者联合使用治疗微静脉畸形的临床疗效和不良反应。方法:联合应用590～1200nm强脉冲光(能量密度12～16J/cm2,脉宽3.0～5.0ms)以及长脉宽1064nm Nd:YAG激光(能量密度80～90J/cm2,脉宽10～20ms)治疗51例微静脉畸形患者;并与单独应用强脉冲光(能量密度13～20J/cm2)及长脉宽Nd:YAG激光(能量密度120～145J/cm2)治疗结果比较。结果:强脉冲光、长脉宽1064nmNd:YAG激光及低能量下联合使用治疗微静脉畸形的有效率分别为33.1%、40.3%和56.9%,瘢痕发生率分别为0%、10.7%和5.9%。结论:低能量下联合使用强脉冲光及长脉宽1064nm Nd:YAG激光提高了微静脉畸形的有效率,且不良反应小。     

长脉冲1064nm Gentle YAG激光联合595nm脉冲染料激光治疗增厚型微静脉畸形回顾性分析

目的：观察长脉冲1064nm Gentle YAG激光联合595nm脉冲染料激光治疗增厚型微静脉畸形的临床疗效和不良反应。方法：使用长脉冲1064nm Gentle YAG激光和595nm脉冲染料激光对14例患者进行治疗,其中长脉冲1064nm Gentle YAG激光能量密度150～240J/cm2,光斑直径3mm,脉宽20～40ms;595nm脉冲染料激光能量密度12～15J/cm2,光斑直径7mm,脉宽6～20ms;共治疗2～7次,间隔时间4～8周。结果：痊愈6例（6/14）,显效5例（5/14）,好转3例（3/14）,无效0例。治疗后出现轻度色素沉着3例（3/14）,均在数月后恢复,遗留增生性瘢痕1例（1/14）,凹陷性瘢痕1例（1/14）。结论：长脉冲1064nm Gentle YAG激光联合595nm脉冲染料激光是目前比较安全、高效的治疗增厚型微静脉畸形的方法。     

窄谱强脉冲光联合长脉宽1064nm激光治疗皮肤血管性病变的疗效分析

目的:探讨窄谱强脉冲光(500～600nm)联合长脉宽1 064nm激光治疗皮肤血管性病变的疗效。方法:使用窄谱强脉冲光(500～600nm)联合Nd:YAG激光长脉宽1 064nm治疗214例血管性病变患者,根据血管性病变的厚度,先用长脉宽1 064nm Nd:YAG激光,然后用窄谱强脉冲光(500～600nm),照射病变部位,治疗1～6次,治疗间隔1个月,门诊随访3～6个月。结果:治愈87例(40.65%),显著消退115例(53.73%),有效9例(4.20%),总有效率94.38%。治疗后出现水疱13例,紫癜10例,色素沉着6例,色素脱失2例,随时间逐渐恢复。结论:窄谱强脉冲光(500～600nm)联合长脉宽1 064nm激光治疗皮肤血管性病变,发挥了强脉冲光和激光的优点,疗效显著,不良反应轻,值得临床推广应用。     

双波长Cynergy激光治疗婴幼儿血管瘤疗效评估

目的探讨双波长Cynergy激光治疗婴幼儿血管瘤的临床疗效及安全性。方法应用双波长Cynergy激光治疗仪治疗婴幼儿血管瘤452例,激光参数为;闪光灯泵浦脉冲染料激光（PDL）10～12J／cm2＋钕：钇-铝-石榴石（Nd：YAG）激光35～60J／cm2,脉冲持续时间;PDL 10ms和Nd：YAG15ms。光斑直径7mm。脉冲延迟：长延迟。采用Cynosure冷风机动态冷却设备（smartcool）,2～4个疗程,间隔为1个月。结果治愈（病灶清除〉75％）326例,占72．12％;显效（病灶清除50％～75％）94例,占20．80％;有效（病灶清除25％～〈50％）32例,占7．08％,无效（病灶消除〈25％）为0。12个月内复发9例,复发率2％。出现瘢痕29例（6．42％）,色素沉着53例（11．73％）;色素脱失24例（5．31％）;色素改变均在4～6个月后自然恢复。头部血管瘤采用两种治疗模式,PDL＋Nd：YAG疗效明显优于PDL,但两种治疗模式的脱发率差异无统计学意义。结论顺序发射波长585DmPDL及1064nmNd：YAG激光的双波长Cynergy激光,是治疗婴幼儿血管瘤的有效方法,起效快、不良反应小。     

优化强脉冲光联合长脉宽Nd∶YAG1064nm激光治疗痤疮瘢痕疗效研究

目的 观察优化强脉冲光联合长脉宽Nd：YAG1064nm激光治疗痤疮瘢痕及其伴发色素沉着、红斑、毛孔粗大临床疗效. 方法 痤疮瘢痕患者共162例,采用随机分组其中78例运用优化强脉冲光联合长脉宽Nd：YAG 1064nm激光治疗,48例运用优化强脉冲光治疗,36例运用长脉宽Nd：YAG 1064nm激光治疗.治疗参数：强脉冲光滤光片640nm,能量密度20～24J/cm2,脉宽4ms,脉冲3个,延迟时间30ms.Nd：YAG1064nm激光,9mm光斑治疗头,能量密度单脉冲58～64J/cm2,脉宽20ms.一疗程5次,每次间隔1个月. 结果 162例患者3种治疗方式ECCA评分差异有统计学意义（P＜0.05）;治疗方式中优化强脉冲光联合长脉宽Nd：YAG1064nm激光治疗组与优化强脉冲治疗组ECCA评分差异有统计学意义（P＜0.05）,优化强脉冲光联合长脉宽Nd：YAG1064nm激光治疗组与长脉宽Nd：YAG1064nm激光治疗组ECCA评分差异有统计学意义（P＜0.05）.痤疮瘢痕及其伴发色素沉着有效率71.19％（95％CI：59.40％～82.98％）,红斑有效率88.14％ （95％CI：79.91％～96.37％）,毛孔粗大有效率71％（95％CI：60.45％～81.97％）.所有患者治疗中未发现任何严重的副作用. 结论 优化强脉冲光联合长脉宽Nd：YAG1064nm激光治疗对痤疮瘢痕及伴有局部色素沉着,红斑,毛孔粗大等都有较好的疗效.     

长脉宽Nd:YAG激光治疗浅表静脉畸形的疗效和安全性研究

目的评价长脉宽Nd:YAG激光治疗浅表静脉畸形的疗效和安全性。方法前瞻性纳入18例浅表静脉畸形患者,采用长脉宽Nd:YAG激光进行治疗,治疗间隔2个月,治疗终点为病灶清除率大于90%,采用治疗前后照片对比进行疗效评价。记录水泡、色沉、毛细血管扩张和瘢痕等不良反应。治疗结束后随访12个月,评价复发率,复发判定标准为治疗后的区域复现10%以上的蓝色血窦。结果经过1～4次(平均2.4次)的治疗,全部患者均可达到90%以上的病灶清除率。不良反应:水泡3人4例次,色素沉着5人9例次,毛细血管扩张3例;无瘢痕增生病例,无复发病例。结论长脉宽Nd:YAG激光可有效治疗浅表静脉畸形,是一种安全有效的方法。     

Nd：YAG 1064nm激光治疗面部毛细血管扩张的临床体会

目的：观察Nd：YAG 1064nm激光治疗面部毛细血管扩张的临床疗效和安全性。方法：应用Nd：YAG 1064nm激光治疗面部毛细血管扩张患者35例,毛细血管直径0.3～1.5mm,光斑直径1.5mm,能量密度280～420J/cm^2,脉宽20～50ms,重复频率1Hz,共治疗1～4次,治疗间隔6～8周。治疗后随访1～6个月,评价治疗效果。结果：35例患者,痊愈18例（51.4%）,显效11例（31.4%）,有效6例（17.1%）,无效0例,有效率82.9%。所有病例均无水疱,紫癜,色素沉着或减退、脱失及瘢痕形成等。结论：在调整好治疗参数的情况下,Nd：YAG1064nm激光治疗面部毛细血管扩张安全、疗效显著,可进一步临床观察应用。     

Coronary laser angioplasty

With the widespread growth of percutaneous transluminal coronary angioplasty (PTC A), the realization of limitations of balloon angioplasty stimulated the development of alternative revascularization approaches such as laser angioplasty. PTCA is best suited for the treatment of discrete atherosclerotic stenoses, with lower success rates and more difficult application in patients with diffuse atherosclerotic disease or total occlusions [1–3]. Moreover, despite an initially high primary success rate, coronary angioplasty is still plagued by a restenosis rate as high as 57% [4]. The potential advantages of laser angioplasty address the limitations of PTCA. In contrast to balloon angioplasty where the plaque material is compressed or displaced, laser angioplasty ablates the plaque material [5]. This bulk removal of plaque material could improve acute procedural success rates, decrease complication rates, treat “untreatable” lesions, and decrease restenosis rates. Because laser energy can vaporize atherosclerotic plaque, there may be no requirement for a preexisting channel, and therefore laser angioplasty may have a high success rate for the treatment of coronary occlusions. In its best embodiment, laser angioplasty offers the potential for passing a fiberoptic catheter through the entire length of the coronary circulation to vaporize all atherosclerotic plaque along the arterial wall. This applicability for the treatment of diffuse atherosclerotic disease would offer treatment opportunities currently unavailable with conventional bypass surgery or angioplasty. © 1994 Wiley-Liss, Inc.     

The influence of hands-on laser training on usage of the CO2 laser

A questionnaire was distributed to all participants in the Rochester General Hospital CO2 laser training workshops for surgeons (1982 to January 1985). The results of this study indicate that, while laser training is necessary prior to being able to use the laser, only a small fraction of trainees actually use the laser in their clinical practice. Surgeons who are using the laser do so in a minority of their cases. New incentives for laser usage must be investigated.     

Present status of laser neurosurgery

A three-fold approach to the status of laser neurosurgery was taken: 1) Questionnaire to Program Directors for neurosurgery training in the United States and Canada; 2) an analysis of titles in the preliminary neurosurgery program of the Fifth International Congress of Neurosurgery; 3) A literature survey covering the last 3 years of publication. The results showed increasing interest in the use of lasers in neurosurgery, especially for neoplasms in brain and spinal canal. The CO2 laser still dominates the field but Neodymium YAG is also finding wide use. The author comments on directions that laser neurosurgery may take in the future. Special emphasis is made on new applications combining advanced technologies, including CAT scanning, ultrasonography, stereotaxic techniques, and computer control.     

Holmium laser prostatectomy

There are three very different topics presented in this section. The authors from Tauranga, New Zealand, who write about holmium laser prostatectomy, have the largest series in the world and were the instigators of this type of treatment for BPH. They address the pros and cons of treating prostatic enlargement in this way and update the reader on the results. Urinary markers for urothelial cancer have been introduced in some numbers in recent years. That so many have been developed leaves one with the feeling that none is completely reliable. The importance to urologists of a urinary marker of any malignancy is clear, and the authors from Ankara review this interesting topic. The management of erectile dysfunction is gradually becoming less invasive and less complicated for patients, but is still very important to urologists worldwide. Many new types of treatment have been recently introduced, and there appear to be more on the way. The authors from New York review the newer agents used for the treatment of sexual dysfunction.     

Clinical aspects of ophthalmic argon laser

This paper reviews the historical events leading to the development of the ophthalmic laser. The formation of the argon laser beam and its biological effects on ocular tissues are outlined, with the major emphasis on the retinal and choroidal tissues. The clinical indications, contraindications, and complications of ophthalmic argon laser photocoagulation for the anterior segment as well as the posterior segment structures of the eye are also thoroughly discussed.     

Reflectance during pulsed holmium laser irradiation of tissue

Although generally ignored in considerations of laser ablation of tissue, reflectance of laser light from tissue during laser-induced ablation is a potentially important factor in determining ablation efficiency because it determines the amount of laser light coupled into the target. To determine the significance of reflectance changes induced by laser irradiation, we examined the reflectance of liver samples during pulsed holmium laser ablation by placing the target at one focus of an ellipsoidal reflector and a detector at the other focus. The temporal behavior, total reflectance, and effect of multiple pulses were examined. Tissue reflectance as large as 50% was observed during holmium laser irradiation but depended upon laser radiant exposure and number of laser pulses. These measurements suggest that changes in the optical properties of the target during ablation are important and should be considered in detailed modeling of the ablation process.     

经尿道接触式激光前列腺切除术

采用Ｎｄ－ＹＡＧ接触式激光仪行经尿道前列腺切除术（ＴＵＬｃ－Ｐ）７６例。９０．６％的患者术后疗效满意，排尿恢复正常者６１．０％，明显改善者２９．６％。术前有剩余尿（３５例）及尿潴留、留置导尿（１１例）的患者，术后１个月４３例恢复正常，仅３例有≤１５ｍｌ剩余尿。认为ＴＵＬｃ－Ｐ操作易掌握，安全，见效快，疗效肯定，对患者打击小。讨论了ＴＵＬｃ－Ｐ的适应证及其局限性。     

调Q1064nm激光和点阵1064nm激光治疗黄褐斑的临床研究

目的:探讨调Q1064nm激光和点阵1064nm激光治疗面部黄褐斑的临床疗效。方法:回顾性分析46例患者的临床资料,A组:24例,用调Q1064nm激光治疗,每月治疗1次,连续治疗5次;B组:22例,用点阵1064nm激光治疗,每2周治疗1次,每例患者治疗10次。两组患者均在疗程结束随访1年后进行评估。结果:A组24例患者经过调Q1064nm激光治疗5次后,临床治愈7例,显效12例,有效5例,无效0例,总有效率79.17%;B组22例患者采用点阵1064nm激光治疗10次后,临床治愈12例,显效7例,有效3例,无效0例,总有效率86.36%;两组总有效率比较无显著差异。结论:采用调Q1064nm激光和点阵1064nm激光治疗面部黄褐斑,有效、安全、无副作用,是目前治疗面部黄褐斑最有效的方法。