激光打孔心肌血运重建术新进展

激光心肌血运重建术(TMIR)是利用激光在缺血的左心室壁制造多个心肌隧道,以促使心腔内的氧合血经隧道注入心肌内,并通过心肌大量的窦状隙及冠状动脉交通网营养该区域心肌。在60年代用针穿刺左心室壁造成孔道改善心肌缺血的基础上Mirhoseini等在70年代末开始了TMLR的实验研究。80年代围绕TMLR的组织学、生理学、生物物理学等方面的研究报道较多,低功率二氧化碳激光TMLR作为冠脉搭桥(CABG)的辅助方法也开始用于临床。90年代在高功率二氧化碳激光成功地用于人心脏跳动下心肌打孔手术后,TMLR成为单独治疗晚期重症冠心病的另一种新方法。1994年尸检发现了激光孔道长期通畅并内皮化及与周围心肌血窦相沟通的组织学证据。近年来,有关TMLR在(1)促进血管内皮生长方面的实验研究,(2)用磁共振成像(MRI)、单光子发射计算机断层(SPECT)和正电子断层扫描(PET)、心肌造影超声(MCE)等手段进行临床随访,(3)临床开展的心脏搏动条件下CABG结合TMLR,(4)TMLR术式及其适应证的选择等实验与临床应用方面均有很大进展。

The Progress of Research and Clinical Applications of Transmyocardial Laser Revascularization

Transmyocardial laser revascularization(TMLR) is a new technique that creates transmuralchannels in ischemic myocardium via laser ablation. Thechannels provide a blood supply for the ischemic my-ocardium by connecting the left ventricular cavity withintramural sinusoid or capillaries. Mirhoseini et al startedtheir initial experimental work on TMLR in the late1970s, on the basis of needle puncture, to salvage theischemic myocardium in the 1960s. A lot of experimentalstudies in morphology, physiology and biophysics onTMLR was performed in many laboratories and TMLRwere performed clinically as an adjunct to CABG withlower - powered carbon dioxide(CO_2) laser in 1980s.TMLR now provides a new treatment alternative for pa-tients with end stage coronary disease, since a high -powered CO_2 laser(800W) device was applicated on thebeating heart of human beings in 1990. The histologicalevidence both of patients, endothelialized tracts withinthe laser - drilled channels which get in communicationwith intramural vessels of the coronary system was de-scribed in 1994. Recently there has been great progressin the research and clinical application of TMLR, such asthe animal study of neoendothelialization of laser - in-duced channels by the application of vascular endothelialgrowth factor, clinical follow - up with Magnetic Reso-nance Imaging Techniques, SPECT and PET, TMLRcombined with CABG without cardiopulmonary bypass,surgical procedure and indication for TMLR.