''" Neovascularization Effect with He- Ne Laser in the Rat Trachea Y. Takahashi. S. Hitomi. I Hirata, T Fukuse, F Yam azaki, K. Cho, and H. Wada Depa rtment of Thorade Surgery Chest Disease ltcsoar ch Institute. Kyoto University. Kyoto, J apa n

The tracheal tissu e of a rat was hete rotopically transplanted benea th the abdomina l skin or a syngenetic rat. an d th e tran splanted graft was irradiate d wit h a He-Ne la ser (2,4 1 J/c m 2). Four or seven days following tra nsplantation. Chinese ink sta ining wa s used to ascertain the number of newly generated vessels. ne ts sacrtnced on day 4 were d ivided Into 3 groups. accordi ng to the number of laser irradation trnaun erus. AO, '\2. and /14. Simila rly, ra ts sacriliced on day 7 were divided into JITOUPS BO, H2 , and B4. Among the A groups, vasc ular counts were 49.5 t 31.1 in gro up AO (n '" 6 ), IOR.9 t 34 ,7 in group A2 (0 '" 7), an d '}O.9 ± 24 .6 in group A4 ( 0 '" 4). Neovascula rization wa s significa ntly mom pronounced in the ir rad iated groups that in the non-irra d iated group. In the B groups, va scu la r coun ts were 14R ± 5R in grou p BO In '" 6). 146 ± 56 in group H2 In '" 5l. an d 147 ± 49 in group B4 In '" 5). Th ere wa s no sign ificant d ifference between the irradiated and non-irra diated B group s . Laser ir radiation wa s determ ined to stimu late neovascuta nxatton. and the possi bility of a elimoal appltca tio n for this proced ure was suggested. Key wo rd s

lIe -Ne Laser - Trac heobronch ial Anastomosis - Wound Ilea ling - Ncovascula rt aauo n - Trachea l Trans plantation

J'\ l'ova sku lnrisa t ions ('fTc kt d ('s Tr a ohealgewebe von Ha tte n

Im -:\ I : - I ~"l s('rs

auf da s

Bcdinj.,'l durch Ztrkulauonsstorungen im Auustumosenbnrr-tch ko nnon Korn phk auonen wie Ik hiszenz und xtenoso nuch hrcnchcplastlschen Einw iffml auftreten . Ilil I l i nwl~isl ~ vorhegen. daf nlede renergetlsches La serficht die Ilcilu ng von Anastomosen giinstig boemfl ussen karin. ha bcn dte Autoron die Einwirk ung des II E-NE-l.asl)rS (2,4 1 J/crn2 ) au f die Nnovasku larisation des Trachealg eweb us bei Ha non uurcrsuclu. Ein 10 mm langcs Segment der Trachea wu rdo vnn orner Haue entnom men. in das Bindegewebe der Ba ur.hwa nd crnor syng erwtischen lIa tte transplamtert und mil dem Hli-Nli -Lasur perkuta n mit 10 mW bestrahlt. vier (Gruppe A) r osp. sleben IGruppr' B) Tagp nach dar Transplantation wurden die Gd1iBt~ durch Inje ktion etner Tu schelos ung in de n hnk en von tnkel in Nnrk usrfixiert un d das Transplantat en monunen. Die Za hl der Gd1i(J1' w urd c in 4 Schrnuen pro Graft ullin dem Mikrnskup gt ,~iihlt_ Die Ilru ppen AO und BO erhtetton ketno Laserhehandlung. A2. B2 wu rden zweima l und A4. H4 vlr-rmal je 5 mi n hes trahlt. l-olgend e Anza hl dor GemOe wurde in den l\ · ( ; ru p pt ~ll vur getunden . AO (n '" 6) 49 ,5 ± 31,1 . A2 (n '" 7) l OX.') ± 34.7 und 1\4 (n '" 4) 90,9 ± 24,(,. Hie Neovas kular-isntion wa r signilikalll mehr ausgepragt in de n beld en hest rahlten (;nJPIWll als in rh-r nicht bestrahlte n Gr up pe. In den H-Gru II]len fo ( gl ~ [)( l () Daten: BO (n '" 6) 14X ± 58. B2 (n '" 5) 14(>± 56 und B4 (n '" 5) 147 ± 49 . Hior lag kein signifikamer Unterschted vor. was zu der Anna hma fuhr-t, daB am 7. postop erauven Tag ore :"it"wilskulari sation beend et ist . l~tst) r1ir.h t stimuliert din NI~ uhi1 d u nl{ von (;nfaBen ; der Mechanismus ist aber unbeka nnt. !las IlE -NE-l k se rlicht ka nn klinisch iiber das flexible Brun choskop appllzlert worden und kcnnto giinstig auf die Hottung von Annstnmosen einwirkun .

Int rod uction In 197 1. E. Master and colleagu es reporte d that low-out put laser ir radia tion acce lerate d wound healing following skin incisions or bum s in mice experiments (13). Ma ny expe rirnents on wo und healing with low-out put lase r irradiation have subsequently been published (8,1 4,1 5). Clinical studies re porting the effectiveness of low-out put laser irradiation in the troatmont of crural ulcer and cervical ectopium have been simila rly presented (9). The trac heobroncho plasty is an anastomosing procedu re commonly used in thorac ic surgery. Complications involving the a nastomosis. such as ste nosis and dehiscence, Thorne. ea rdiov a sc. Surgeon 40 (19 9 2) 28 8 -291 © Georg Thieme Verlag Stuttgart - New York

arise in a few percent of surgical eases. Complicat ions at the anastomosis a re most com monly caused by poor blood flow foUowingexte nsive dissection. Currently, tracheobronchial a nastomosis constitutes one of the majo r pro blems in clinical lung tra nsplan tation. a nd in resection of the tracheal bifurcat ion. Wra pping: with the greater omentum has been att empted as a preventative measure (4). but this procedu re does not always preclude complications (15), a nd is not possible in pa tients who haw lost the greater omentum in previous abdominal surgeries. Accordingly, other mensures which accelera te wound healing at the tracheobrcnchial a nastomosis need to be devised (16).

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Sum mary

!\ 'f'UI'a,W',da ri:atiu/I J:fff'ct Il'ith Ile-,".'e l.asrr ill I11f' Rat Trachea

~I a t ('rial s

a nd

Hmlu'dding

~ I('th ods

of tl/(' syngenetic tra chea l graft

Following the Intravenous injec tion of 0.5 ml of heparin. inbn-d spedfic pa thogen -free dono r ra ts (F344 /N S Ic males !I- X weeks old a nd \\'('ighing 1:m -txII g, as su pplied by Ja pa n SLC lnc.], were sacrific:t'd under oth er anesthes ia. I\. I (I III III seg meru of trac hea below the first ca rtilage r ing a t lim tnrerfor poll! of th e thyro id, was as eptically rese cted and used for the gra ft. The abdomen of syng enetic red ptem ra t." wa s sha ved an d a 2 ern med ian incision wa s ma de. Asepuc techniq ue wa s used ttl leave the trachea l gra il within ti m su bcutaneous layer, TIlt! skin was sutured with 5·11 prolene thread. an d the trans planted trachea was palpnhlo under the skin.

Las er irradia tion He r-ipien t ra tss WNt' divided into gro ups according to las er irrad iation times and day of sa crifice. Groups A a nd B were secr ino-d on postoperative da ys 4 a nd 7. respectively. Rats of group A were furth er divided into grnups 11.0, 11.2. a nd /1.4 , accordin g to la ser irradiation frequency and group B was similarly d ivided into groups HO. H2, and B4. Treatmont was as follows: Group All: No laser irradiation treatment wa s per form ed. The rats were sac rificed four days afte r trans plan-

tauun . Grou p A2: I...i ser irrad iation was performed twice , on till' day of transpla nta tion and the following day. The ra t" wer e slll:rifit'l!d four da ys a fte r tran sp la nta tion . Croup A4: 1.1ISBr irra diation was performed four times. onrn a da y I)( ~ginnin g on the day of tra ns pla ntation. Tho ra ts were sa rrl flced four da ys after trauspluntauon . (;ro up BO; No laser irrnd lauon tre atment wa s perfurnuul. The rats were sa cr ificed se ven da ys after transplan 1