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.     

Efficacy of the Nd YAG Laser in the treatment of superficial cutaneous vascular lesions

On the basis of accumulated clinical experience, there is some information available about the treatment of vascular lesions with lasers especially the pulse dye laser. Our study aims to assess the efficacy of Nd YAG lasers in the management of cutaneous vascular lesions and compare results with previously published work on the Nd YAG laser, the Pulse Dye Laser, and Intense Pulsed Light (IPL). The apparatus used was the Combined IPL–Nd YAG Laser system from AK lasers. Fifteen patients volunteered with thread veins, spider naevi, and telangectasia. The treatments were given on an outpatient basis, and results were reassessed at 1 month. The results were generally disappointing at 1 month. Ten patients had no improvement. Five patients treated on the face had minimal to moderate improvement. Although the Nd YAG laser showed dramatic immediate results, in the long run, its use proved disappointing for cutaneous venous lesions of the lower limbs, although the results for facial lesions are better and in keeping with previous studies.     

长脉宽Nd:YAG激光治疗皮肤血管性病变的临床研究

目的 探讨波长为1064nm的长脉宽Nd:YAG激光治疗皮肤血管性疾病的疗效.方法 采用长脉宽Nd:YAG激光治疗鲜红斑痣、蜘蛛痣、毛细血管扩张等皮肤血管性病变,根据病变的不同选择不同的治疗参数,并对疗效进行分析.结果 本组患者215例获随访1年,长脉宽Nd:YAG激光治疗鲜红斑痣的痊愈率为15.4%,显效率为53.8%;治疗蜘蛛痣的痊愈率为76.8%,显效率为17.9%;治疗毛细血管扩张的痊愈率为18.6%,显效率为60.2%;治疗其他血管性病变的痊愈率为18.2%,显效率为54.5%.12例(5.6%)患者在术后发生了短暂性色素沉着;5例(2.3%)患者在术后发生了轻度瘢痕,无严重并发症发生.结论 长脉宽Nd:YAG 激光是一种治疗皮肤血管性病变安全、有效的方法.     

A side-by-side prospective study of intense pulsed light and Nd:YAG laser treatment for vascular lesions

Recently, lasers and light systems are used more for the treatment of vascular lesions due to their noninvasiveness, ease of use, and short recovery time. This side-by-side prospective study compares results, satisfaction, and complications after intense pulsed light (IPL) and Nd:Yag laser treatment of small vascular lesions. Twenty-five patients with telangiectases, leg veins, or cherry angiomas underwent treatment of the same category of lesion in the same area. One year after completing treatment, patients were asked to report their satisfaction level after comparing digital photos before and after treatment; 72% felt they had good to excellent results after Nd:Yag treatment, while only 48% felt the same after IPL. The most common side effect after Nd:Yag was hyperpigmentation. Satisfaction level was significantly higher after Nd:Yag than after IPL. Patients with telangiectases, cherry angiomas, or leg veins <1 mm were more satisfied after IPL, while those with leg veins >1 mm were more satisfied after Nd:Yag. Overall, satisfaction with treatment of vascular lesions was greater with Nd:Yag although this method was more painful.     

Nd:YAG laser followed by radiation for treatment of malignant airway lesions

Patients with malignant obstructive airway lesions often present with total or segmental atelectasis of lung. In spite of prompt initiation of palliative external radiation alone, some patients were unable to complete the planned course of radiation therapy. Since May 1983, 17 patients with malignant obstructive endobronchial lesions have been treated by endoscopic Nd:YAG laser vaporization of the tumor. One to seven days later, fractionated external radiation therapy was initiated. Endoscopic use of the laser was repeated as needed during the course of treatment. Fifteen out of 17 patients successfully completed the planned course of therapy. The improved performance status was sustained in 13 of 15 patients for 2-13 months. A control group was selected from among patients with similarly located lesions who underwent external radiation treatment only prior to the availability of the Nd:YAG laser therapy. One patient developed radiation pneumonitis six weeks after completion of a second course of external radiation, another patient developed bronchopleural fistula after laser treatment which healed following closed chest tube drainage. The others had longer palliation of symptoms and improved quality of life. The results indicate that relief of airway obstruction by use of the Nd:YAG laser improved the patients' ability to tolerate subsequent external radiation treatment.     

The Nd: YAG laser in the treatment of colonic polyps

The result of Nd: YAG laser therapy in 31 patients with pathologically verified rectosigmoid polyps was presented. Except one case with large adenomatous polyp recurring two months after the primary treatment, all other patients were cured clinically on their first therapy. There were no severe complications, and the longest follow-up period was 14 months. The authors came to the conclusion that compared with other modalities, Nd: YAG laser therapy is safe, effective, and low recurrence rate.     

Nd:YAG激光治疗皮肤血管性病变980例回顾性临床分析

目的:探讨波长为532nm的Nd:YAG激光治疗皮肤血管性病变的疗效及影响因素。方法:采用Nd:YAG激光治疗毛细血管畸形、毛细血管瘤、毛细血管扩张和血管痣等皮肤血管性病变,根据皮损的不同性质选用不同的激光能量进行照射,对980例皮肤血管性病变患者进行回顾性分析。结果:Nd:YAG激光对不同皮肤血管性病变的疗效有显著性差异(χ2=300.418,P<0.05)。多因素分析显示:毛细血管畸形的疗效与病变面积、颜色、病程、治疗次数、激光能量及光斑大小有关;毛细血管瘤的疗效与治疗面积、次数、激光能量及光斑大小有关;血管痣的疗效与治疗次数、激光能量有关;毛细血管扩张的疗效与部位有关(P<0.05)。术后出现暂时性色素沉着5例(0.5%),轻度瘢痕4例(0.4%)。结论:Nd:YAG激光治疗皮肤血管性病变疗效较好,安全性高。     

倍频Nd:YAG 532nm 波长激光治疗皮肤血管异常性疾病的临床应用研究

观察可变脉宽５３２ｎｍ波长激光治疗皮肤血管异常性疾病的效果。用不同脉宽的ＶＰ５３２ｎｍ波长激光结合冷却疗法治疗各种皮肤血管异常性疾病，观察其疗效及并发症。治疗鲜红斑痣、草莓样血管瘤、蜘蛛样血管瘤、血管痣、毛细血管扩张等皮肤血管异常性疾病共１３８例，均取得了满意的疗效，较传统的方法相比，疗效更为明显。可变脉宽５３２ｎｍ波长激光治疗皮肤血管异常性疾病效果可靠，治疗时辅以冷却治疗对防止局部过度损伤及术后色素沉着均有重要意义     

Q开关Nd：YAG激光治疗皮肤色素增加性疾病的疗效观察

目的：探讨倍频Nd：YAG激光治疗皮肤色素增加性疾病（太田痣、雀斑、脂溢性角化病）的临床疗效,并进行比较。方法：采用调Q开关Nd：YAG激光美容仪,治疗时根据不同的病变特点,选择不同的治疗参数。色素性病变患者180例,其中雀斑60例,太田痣60例,脂溢性角化60例。三个病种分别分为治疗组（30例）和对照组（30例）,雀斑、脂溢性角化病治疗组采用532nm激光治疗,太田痣治疗组采用1064nm治疗,各对照组均采用1064nm和532nm两种激光组合治疗;各组分别治疗4次后,每次间隔1～3个月,观察疗效。结果：雀斑治疗组和对照组疗效差异无统计学意义（χ^2=1.23,P〉0.05）,太田痣治疗组和对照组疗效差异有统计学意义（χ^2=5.4,P〉0.05）,脂溢性角化治疗组和对照组疗效差异有统计学意义（χ^2=4.27,P〉0.05）。结论：Q开关Nd：YAG激光仪治疗皮肤色素增加性疾病,个性化治疗有重要意义。     

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.     

Experience with the Nd:YAG laser in the treatment of keloid scars

Numerous therapeutic modalities have been espoused for the treatment of keloids. In the laboratory, great strides have been made in understanding the connective tissue pathobiology that underlies this problem. Unfortunately, no consistent treatment has been found to prevent the development of surface overhealing. Moreover, all forms of therapy designed to treat this condition have produced inconsistent results. This article documents the use of the Nd:YAG laser in the treatment of 20 patients with keloid scars. Candidates for the study included patients with no previous therapy and those who had prior treatment with steroids and/or surgery with no improvement. Although the use of Nd:YAG laser for keloids continues to be investigational, our results appear promising. Success of therapy was judged by softening and flattening of the scar. Laboratory studies provide a basis for understanding the possible effect of connective tissue metabolism with the Nd:YAG.     

Nd：YAG激光治疗外源性皮肤色素性疾病

目的观察NdYAG激光治疗外源性皮肤色素性疾病的疗效及并发症。方法用Q开关倍频Nd∶YAG激光治疗不同部位的外源性皮肤色素性疾病,用特定波长治疗不同颜色的纹身、纹眉及外伤性刺青等。结果共治疗406例,有效率达100％。结论NdYAG激光治疗如文眉、文身等外源性色素性疾病效果良好,对面积大、部位深的病变需多次治疗方可彻底治愈,较现有其它常规方法有更多的优点。     

The treatment of cutaneous vascular lesions with the infra-red coagulator: a preliminary report

The treatment of vascular naevi with lasers is widely practised. The concept of specific vascular damage was an early ideal but it is much harder to attain than had been anticipated. The favourable results achieved by coagulation necrosis of the epidermis and upper dermis with the argon and CO2 lasers prompted us to try to produce the same changes with non-laser radiation. We have used an infra-red coagulator to treat flat vascular naevi and ectatic blood vessels. The handpiece which looks like a gun has a light guide capped by a 6 mm diameter sapphire. This size combined with a pulse duration of less than 1.0 second enables large areas of skin to be treated quickly. Preliminary results are presented.     

The Nd:YAG laser in neurological surgery

The Nd:YAG laser has been applied in microneuro-surgery and has been found to be quite effective in removing had and hemorrhagic tumors such as meningiomas, tumors of the deep skull base, or tumors deep in the ventricle. Another indication for the use of the Nd:YAG laser is to open the thick sellar floor in transsphenoidal operations.     

The use of the Nd:YAG laser in urology

The use of the neodymium:YAG(Nd:YAG) laser in urology in still in its infancy. To date, the most widely published application of this laser is in the treatment of bladder carcinoma. We have utilized the Nd:YAG laser in 23 treatments for superficial bladder tumors. The laser has both advantages and shortcomings, which are thoroughly addressed. In our hands the laser has been a safe instrument for the treatment of these lesions, although we do not recommend its use for tumors greater than 3 cm. We have treated two patients with invasive disease one week prior to planned cystectomy. In one case, no residual tumor was found at cystectomy, while the second patient had viable tumor only in an untreated area. Two patients were successfully treated with the laser for intractable bladder bleeding, one each with primary and secondary bladder tumor. Seven patients with condylomata acuminata were treated with laser therapy. All had excellent results without complication. One patient with urethral bleeding secondary to trauma was treated without success, while one patient with a urethral hemangioma was well treated with the Nd:YAG laser. Thus the Nd:YAG laser would appear to have a place in the urologic armamentarium, but whether it is cost-effective for widespread use remains to be seen.     

倍频Nd:YAG532nm波长激光治疗鲜红斑痣疗效观察

目的 :观察倍频Nd :YAG5 32nm波长激光治疗鲜红斑痣效果。方法 :1997年 3月至 1999年 10月 ,选择其可变脉宽 5 32nm波长激光治疗鲜红斑痣 387例 ,治疗过程中同时使用冷却头冷却皮肤 ,每次治疗间隔 2～ 3个月。结果 :平均治疗 5 .6次 ,总有效率 95 %。 15例出现暂时性色素沉着 ,3例皮肤出现点状萎缩性瘢痕 ,6个月后均消退 ,2例出现增生性瘢痕。结论 :可变脉宽 5 32nm波长激光治疗鲜红斑痣效果良好 ,并发症少 ,是目前较理想的治疗方法     

倍频Nd:YAG532nm波长激光治疗鲜红斑痣疗效观察

目的:观察倍频Nd:YAG532nm波长激光治疗鲜红斑痣效果.方法:1997年3月至1999年10月,选择其可变脉宽532nm波长激光治疗鲜红斑痣387例,治疗过程中同时使用冷却头冷却皮肤,每次治疗间隔2～3个月.结果:平均治疗5.6次,总有效率95%.15例出现暂时性色素沉着,3例皮肤出现点状萎缩性瘢痕,6个月后均消退,2例出现增生性瘢痕.结论:可变脉宽532nm波长激光治疗鲜红斑痣效果良好,并发症少,是目前较理想的治疗方法.