CO₂Laser와 쌍극전기 소작에 의한 혈관응고 및 혈관수복효과에 관한 실험 = CO₂laser and Bipolar Electrocautery Effects on Vessel Coagulation and Arterial Repair

다국어 초록 (Multilingual Abstract)

Hemostatic effect is achieved most efficiently by bipolar electrocoagulation in the neurosurgical operation. As far as function is concerned, the laser surgical unit closely resembles the electrosurgical unit.
It has been possible to unite arterial vessel ends in a very fast procedure by means of heat application with the laser or bipolar electrocautery.
The authors studied the difference between the CO₂laser and bipolar electrocautery effect on coagulation and anastomosis of vessels experimentally. 46rats weighing 200gmto 250gm, were used in this study. We divided the expermental animals into 4 groups : A) vessel coagulation group : 1) arterial coagulation with the CO₂laser (10 rats), 2) vessel coagulation with the bipolar electrocautery(10 rats), B) arterial repair group : 1) arterial anastomosis with the CO₂laser (16 rats), 2) arterial anastomosis with the bipolar electrocautery(10 rats). The CO₂laser was operated at 10watts(W) to 50W for vessel coagulation, and 2W for arterial anastomosis. The output of bipolar generator (Malis type) varied from 10 to 80 dial setting (DS) for coagulation of artery and vein or arterial anastomosis.
The results obtained were as follows:
1) The lower of proper arterial coagulation by the CO₂laser was 20W, 3 seconds(sec) of exposure time with defocused beam.
2) The arteries were properly coagulated with the bipolar coagulator under the DS 30-40. coagulation time 2-4 sec. Over DS 50, the artery perforated to active bleeding.
3) The veins were coagulated satisfactorily under DS 20-30 with 1-5 sec, of coagulation time.
4) Both temporary cease of blood flow and using blunt bipolar forceps reduced the coagulation time, and the arteries were not perforated over DS 50.
5) Aerial anastomosis was accomplished with 2W, 0.05 sec of exposure with 0.2㎜ of focused CO₂laser beam. With the bipolar coagulator, the arteries could be anastomosed under DS 5-10, 2-3 sec, of coagulation time.
6) The patency rate after arterial anastomosis was 71% with the CO₂laser, and was 22% with the bipolar coagulator.
7) On the histological examination of coagulated arteries, the entire layers of laser irradiated side revealed destruction and constriction while opposite side was relatively well preserved., on the contrary, the arteries coagulated with bipolar coagulator showed destruction of adventitia and media, sparing intima on whole circumference of the vascular wall. Anastomosed site revealed well coaptation of adventitia and media. KEY WORDS: CO₂laser. Bipolar coagulation·Vessel coagulation·Arterial repair·Arterial anastomosis.