Dokument

Zusammenfassung:
Hintergrund: Lungenmetastasen können mit einem Laser nicht anatomisch reseziert werden. Dabei erzeugt der Laser auf der Resektionsfläche eine Koagulationsschicht, die die Lunge nach außen abdichtet. Bisher ist unklar, ob die Resektionsfläche zusätzlich übernäht werden sollte. Ein Verzicht auf eine Naht würde zu einer geringeren Restriktion des Lungengewebes führen und eine bessere Entfaltung und Heilung der Lunge begünstigen. Methodik: Mit einem Thulium Laser Vela® QI wurden an parakardialen Schweinelungenlappen nicht anatomische Lungenparenchymresektionen in drei verschiedenen Schnitttiefen (0,5 cm, 1,0 cm, 2,0 cm) durchgeführt. Jede Resektionstiefe wurde mit drei unterschiedlich dicken Laserfasern (230 μm, 365 μm, 600 μm) und bei zwei unterschiedlich hohen Laserleistungen (10 W, 30 W) durchgeführt. Anschließend wurden die Lappen über einen Tubus mit einem Beatmungsgerät verbunden und beatmet (Flow: 20 l/min, PEEP: 5 mbar, Pinsp: 15 mbar). Die Resektionsflächen wurden auf Luftdichtigkeit überprüft, und durch Steigerung des inspiratorischen Druckes wurde der Berstdruck der Resektionsflächen ermittelt. Alle Schnittflächen wurden histologisch untersucht, und die Dicke der Koagualtionszone wurde bestimmt. Ergebnisse: Unter Einsatz der 600 μm Laserfaser wurde in allen Resektionstiefen und bei beiden Laserleistungen (10 W, 30 W) eine 100%ige Luftdichtigkeit gemessen. Mit der 230 μm und 365 μm Laserfaser konnte insgesamt keine initiale Luftdichtigkeit beobachtet werden. Luftundichtigkeiten wurden unserer Erkenntnis nach hauptsächlich durch eröffnete Segmentbronchi in den Resektionsflächen verursacht. Der mittlere Berstdruck war mit der 600 μm Laserfaser im Vergleich zu den beiden anderen Fasern stets am höchsten. Er lag mit der 600 μm Faser und 30 Watt Leistung bei 41,6 ± 3,2 mbar (0,5 cm) bzw. 33,7 ± 4,8 mbar (2,0 cm). Auch die mittlere Dicke der Koagulationszone war unter Verwendung der 600 μm Laserfaser am breitesten (315,5 ± 6,4 μm bei 30 W). Schlussfolgerung: Bei Lungenparenchymresektionen mit einem Thulium Laser (600 μm Laserfaser, 30 W Leistung) kann auf eine Übernähung verzichtet werden, da die Resektionsflächen initial luftdicht sind und ausreichend hohe Berstdrücke erreicht werden. Zur Sicherheit sollten die Resektionsflächen auf eröffnete Segementbronchi - 63 - abgesucht werden und diese mittels einer Naht verschlossen werden. Diese Ergebnisse sowie die permanente Luftdichtigkeit der Resektionsflächen nach Laserresektion mit einem Thulium Laser sollten in weiteren experimentellen und klinischen Studien untersucht werden.

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