I-laser ye-Long-pulsed 1064 Nd:YAG ibonakalise ukuba ilunyango olusebenzayo lwe-hemangioma kunye nokukhubazeka kwemithambo yegazi kwizigulana ezimnyama zesikhumba, kwaye iingenelo zayo eziphambili kukuba yinkqubo ekhuselekileyo, enyamezelekayo, engabizi kakhulu enexesha elincinci lokungasebenzi kunye nemiphumo emibi embalwa.
Unyango lwe-laser lwemithambo yemilenze engaphantsi nenzulu kunye nezinye izilonda zemithambo yegazi luseyenye yezona ndlela zixhaphakileyo zokusetyenziswa kwe-laser kwi-dermatology nakwi-phlebology. Enyanisweni, ii-laser ziye zaba lunyango olukhethwayo lweempawu zokuzalwa zemithambo yegazi ezifana ne-hemangiomas kunye ne-port-wine stains kunye nonyango oluchanekileyo lwe-rosacea. Uluhlu lwezilonda zemithambo yegazi ezingenabungozi ezizalwa nazo ezinyangwa ngempumelelo nge-laser luyaqhubeka nokwanda kwaye luchazwa ngumgaqo we-selective photothermolysis. Kwimeko yeenkqubo ze-laser ezithile zemithambo yegazi, injongo ekujoliswe kuyo yi-intravascular oxyhemoglobin.
Ngokujolisa i-oxyhemoglobin, amandla adluliselwa eludongeni lwemithambo yegazi ejikelezileyo. Okwangoku, i-laser ye-1064-nm Nd: YAG kunye nezixhobo ze-visible/near infrared (IR) intense pulsed light (IPL) zombini zinika iziphumo ezilungileyo. Nangona kunjalo, umahluko ophambili kukuba ii-laser ze-Nd: YAG zinokungena nzulu kakhulu kwaye ke ngoko zifanelekile ngakumbi kunyango lwemithambo yegazi emikhulu, enzulu efana nemithambo yemilenze. Enye inzuzo ye-laser ye-Nd: YAG kukuba i-absorption coefficient yayo ephantsi ye-melanin. Ngomlinganiselo ophantsi wokungenisa i-melanin, akukho nkxalabo ingako ngomonakalo we-collateral epidermal ngoko ke ingasetyenziswa ngokukhuselekileyo ukunyanga izigulane ezinombala omnyama. Umngcipheko we-hyper pigmentation emva kokudumba unokunciphisa ngakumbi zizixhobo zokupholisa i-epidermal. Ukupholisa i-epidermal kubalulekile ukukhusela umonakalo we-collateral ovela kwi-melanin absorption.
Unyango lwemithambo yemilenze yenye yezona ndlela ziceliweyo zokuhombisa. Ii-venules ezivuselelayo zifumaneka malunga nama-40% abafazi kunye ne-15% yamadoda. Ngaphezulu kwama-70% banembali yosapho. Rhoqo, ukukhulelwa okanye ezinye iimpembelelo zehomoni ziyabandakanyeka. Nangona ingxaki yokuhombisa iphambili, ngaphezulu kwesiqingatha sale mithambo inokuba ziimpawu. Inethiwekhi yemithambo yinkqubo entsonkothileyo yemithambo emininzi ye-caliber kunye nobunzulu obahlukeneyo. Ukuphuma kwemithambo yemilenze kuqulathe imijelo emibini ephambili, i-plexus yemisipha enzulu kunye ne-plexus yesikhumba engaphezulu. Le mijelo mibini iqhagamshelwe yimithambo enzulu egqobhozayo. Imithambo emincinci yesikhumba, ehlala kwi-dermis ephezulu ye-papillary, iphuma iye kwimithambo enzulu ye-reticular. Imithambo emikhulu ye-reticular ihlala kwi-dermis ye-reticular kunye namafutha angaphantsi komhlaba. Imithambo engaphezulu inokuba nkulu njenge-1 ukuya kwi-2 mm. Imithambo ye-reticular inokuba ngu-4 ukuya kwi-6 mm ngobukhulu. Imithambo emikhulu ineendonga ezijiyileyo, inoxinzelelo oluphezulu lwegazi elingena-oxygen, kwaye inokuba ngaphezu kwe-4 mm ubunzulu. Utshintsho kubungakanani bemithambo yegazi, ubunzulu, kunye ne-oxygenation luchaphazela indlela yokusebenza kunye nokusebenza kakuhle konyango lwemithambo yemilenze. Izixhobo zokukhanya ezibonakalayo ezijolise kwiincopho zokufunxwa kwe-oxyhemoglobin zinokwamkeleka ekunyangeni ii-telangiectasias ezingaphezulu kakhulu emilenzeni. Iilaser ezinde, ezikufutshane ne-IR zivumela ukungena nzulu kwezicubu kwaye zinokusetyenziselwa ukujolisa imithambo enzulu ye-reticular. Iiwavelength ezinde zikwashushu ngokulinganayo kuneewavelength ezimfutshane ezinee-coefficients eziphezulu zokufunxwa.
Iindawo zokuphela konyango lwemithambo yelaser kukuphela kwemithambo yegazi ngoko nangoko okanye ukuqhekeka kwemithambo yegazi okubonakalayo okanye ukuqhekeka. I-Microthrombi inokuba nomtsalane kwi-lumen yemithambo yegazi. Ngokufanayo, ukuphuma kwegazi kwimithambo yegazi kunokubonakala ngokuqhekeka kwemithambo yegazi. Ngamanye amaxesha, ukuvakala okuvakalayo kunokubonwa ngokuqhekeka. Xa kusetyenziswa ixesha elifutshane kakhulu lokubetha kwentliziyo, ngaphantsi kwe-20 milliseconds, kunokubakho i-purpura enobukhulu bamabala. Oku kusenokwenzeka ukuba kungenxa yokufudumeza ngokukhawuleza kwemithambo yegazi kunye nokuqhekeka kwayo.
Utshintsho lwe-Nd: YAG olunee-spot sizes eziguquguqukayo (1-6 mm) kunye ne-fluences ephezulu luvumela ukususwa kwe-focal vascular kunye nomonakalo omncinci wezicubu ezidibeneyo. Uvavanyo lweklinikhi lubonise ukuba ubude be-pulse phakathi kwe-40 kunye ne-60 milliseconds bubonelela ngonyango olufanelekileyo lwemithambo yemilenze.
Eyona miphumo mibi ixhaphakileyo yonyango lwe-laser kwimithambo yemilenze kukufakwa kwebala emva kokudumba. Oku kubonakala rhoqo kwiintlobo zolusu ezimnyama, ukuchatshazelwa lilanga, ubude bentliziyo obufutshane (<20 milliseconds), imithambo eqhekekileyo, kunye nemithambo enee-thrombus. Iyaphela ngokuhamba kwexesha, kodwa oku kungathatha unyaka okanye ngaphezulu kwezinye iimeko. Ukuba ubushushu obugqithisileyo buziswa kukukhanya okungafanelekanga okanye ubude bentliziyo, izilonda kunye namanxeba alandelayo anokulandela.
Ixesha lokuthumela: Oktobha-31-2022