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접촉성 Neodymium: Yttrium Aluminum Garnet(Nd: YAG) 레이저를 이용한 토끼 자궁각문합술
전준연 ( Joon Yeon Jun ),정선안 ( Sun An Jung ),송영훈 ( Young Hun Song ),고영미 ( Young Me Koh ),김장흡 ( Jang Heub Kim ),김진홍 ( Jin Hong Kim ),이진우 ( Jin Woo Lee ),김수평 ( Soo Pyung Kim ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12
This study was aimed to determine the feasibility of using the Nd: YAG laser with a synthetic sapphire contact tip to weld the transected rabbit uterine horns and to compare the effects of conventional microsurgical anastomosis with Nd: YAG laser welding of the uterine horns. Forty -eight rabbit uterine horns were transected and subjected to microsurgical anastomosis(control group, 16 uterine horns) or laser welding(laser group, 32 uterine horns). The laser group was divided into 3 subgroups based on the different laser power levels; 4, 5, and 6 watts level were applied to 8, 8, and 16 uterine horns, respectively. The surgical time of each procedure were recorded. Four weeks later, a laparotomy was performed to determined adhesion formation and uterine horn patency, and a histologic examination was done of the anastomosis sites. The results were as follows: 1. In the case of a unilateral uterine horn anastomosis, control group required significantly longer operation time(30.2±2.1 minutes) than 4, 5, or 6 watts laser group(9.3 ± 1.5, 8.2 ± 1.3, 8.5 ± 0.7 minutes, respectively). 2. Laser group produced slightly less adhesion(adhesion score, 1.09±0.78) than control group(l.44 ±0.96), but there was no significant difference. 3. One of 16 uterine horns in control group(6.3%) and one of 32 in laser group(3.l%) were not patent by chromopertubation using methylene blue. The leakage of methylene blue at the anastomosis sites were 6.3% in control group and 12.5% in laser group. Thus, the patency rate(without occlusion and leakage) were 87.5% in control group and 84.4% in laser group, whose result does not show significant difference. Meanwhile, laser group with 6 watts power level showed 1000%patency rate. 4. There were fewer constrictions at the anastomosis sites in laser group than control group in some rabbits. In other rabbits, the uterine homs were equally smooth. Microscopically, well-healed mucosal layer and minimal inflammation at the anastomosis aites were observed in laser group, but there were irregular mucosal layer, thin and mildly disrupted muscularis layer with some fibrosis, moderate inflammation, and foreign body granulomas were found in control group. 5. The contact Nd: YAG laser with a synthetic sapphire tip was found to be able to weld the transected rabbit uterine homs successfully. The most appropriate power level was 6 watts in the experiment. In conclusion, the patency rates were similar between the control and Nd: YAG laser group. But less operation time and simple manipulation of Nd: YAG laser might enable clinicians to get a better results on the tubal reconstruction.