激光技术在医疗应用中的机遇与挑战

来源:荣格、丁香园    关键词:激光医疗, 钬激光, 治疗,    发布时间:2018-12-17

设置字体:

激光自诞生之初,就有科学家尝试将其应用于医疗中。近年来,由于激光技术应用快速拓展,欧美等国家在激光医疗及美容领域取得了一系列的突破!


发展新常态

近几年来,我国经济在转型升级中步入中高速发展的“新常态”,战略性新兴产业和生产性服务业逆势上行,逐渐成为拉动经济增长的两大“新引擎”

激光行业面临的机遇与挑战

根据国际某激光行业权威刊物2014年发布的统计资料表明。全球能量激光和信息激光的总产值超过1000亿美元,其中能量激光产业300亿美元,国际领先企业的收入状况表明: 整体激光产业的增长幅度将在10%左右;具有先进技术的领先企业增长速度将超过50%;激光设备整体销量受宏观经济影响较大。


激光器产品在航空航天、能 源、交通运输、医疗设备以及金属制品等不受经济衰退影响的市场领域,业绩增长良好。新一轮的科技革命不断催生着新的业态,智能制造、激光3D打印等新的应用领域不断拓展延伸;技术、产业跨界融合催生新的商业模式。


钬激光可用于泌尿外科、五官科、皮肤科、妇科等科室手术,是一种相对较新的多用途医用激光。该激光手术为无创或微创手术,病人的治疗痛苦非常小。

钬激光是以钇铝石榴石(YAG)为激活媒质,掺敏化离子铬(Cr)、传能离子铥(Tm)、激活离子钬(Ho)的激光晶体(Cr:Tm:Ho:YAG)制成的脉冲固体激光装置产生的新型激光。可应用于泌尿外科、五官科、皮肤科、妇科等科室手术。

钬激光在泌尿外科的临床应用

1. 钬激光治疗泌尿系结石

原理和特点:钬激光对结石的碎石作用主要通过一种「钻孔效应」,由此结石被「汽化」,形成细小的结石微尘。钬激光以脉冲式发射,发射时间为 0.25 s,瞬时间功率可达 10 kW,足以粉碎各种成分和密度的结石,其组织穿透深度 <0.5 mm,组织损伤轻微,不易形成瘢痕,术后不会导致尿路狭窄。


2. 钬激光治疗良性前列腺增生

包括钬激光前列腺切除术和钬激光前列腺剜除术。第一种是通过钬激光将前列腺分层、分块切除成碎块,经尿道取出,而另一种能将前列腺沿着外科包膜分块剜除,再经尿道用组织粉碎器将前列腺组织块切碎吸出。

目前经尿道前列腺电切术被认为是治疗良性前列腺增生的首选。钬激光治疗前列腺增生相对 TURP 和开放手术疗效相当,更具安全性,且对各种大小的前列腺都适用,有望成为主要手术方式。


3. 钬激光治疗泌尿系统肿瘤

钬激光治疗膀胱肿瘤的适应证:易复发、体积小、位置表浅、低分化乳头状瘤。

目前浅表性膀胱癌的标准治疗是经尿道膀胱肿瘤电切,术后给予膀胱灌注化疗。目前认为钬激光可以安全地治疗体积较小的膀胱非浸润性尿路上皮肿瘤,其治疗效果至少和标准的 TURBT 效果类似。也有报道,钬激光用于上尿路移行细胞癌的治疗。

优点:方向性好,而穿透性弱,使用较安全,不易造成膀胱穿孔。并且具有精确的切割和良好的凝固特性,从而达到既可完整切除肿瘤,又确保对周围组织无意外损伤。



4. 钬激光治疗泌尿系统狭窄

特点:由于钬激光汽化性能良好,穿透深度表浅,经腔内治疗尿路狭窄,可以有效地汽化切割瘢痕组织,对周围正常组织热损伤很小,促进创面吸收、修复、上皮化,不易复发收缩狭窄,手术时间短,术后恢复快。

另外钬激光还可用于其他泌尿系统的内切开,如先天性巨输尿管症的内切开、尿路改道后输尿管肠道吻合口狭窄的内切开等。


5. 钬激光在泌尿外科的其他用途

钬激光还可用于其他泌尿外科的手术,如腺性膀胱炎、尖锐湿疣等疾病。有学者报道通过腹腔镜应用钬激光进行各种腹腔镜手术,钬激光在泌尿外科中的应用还需进一步探索。

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