I-laser ye-Long-pulsed 1064 Nd:YAG iyindlela yokwelapha ephumelelayo ye-hemangioma kanye nokukhubazeka kwemithambo yegazi ezigulini zesikhumba esimnyama ngezinzuzo zayo ezinkulu zokuba inqubo ephephile, ebekezelelwa kahle, engabizi kakhulu enesikhathi esincane sokuphumula kanye nemiphumela emibi emincane.
Ukwelashwa nge-laser kwemithambo yemilenze ejulile nengaphezulu kanye nezinye izilonda zemithambo yegazi kusengenye yezindlela ezivame kakhulu zokusebenzisa i-laser kwezokwelapha isikhumba kanye ne-phlebology. Eqinisweni, i-laser isibe yindlela yokwelapha ekhethwa kakhulu yezimpawu zokuzalwa zemithambo yegazi njenge-hemangiomas kanye namabala e-port-wine kanye nokwelashwa okuqondile kwe-rosacea. Uhlu lwezilonda zemithambo yegazi ezingenabungozi ezizalwa nazo kanye nezitholwe nge-laser luyaqhubeka nokukhula futhi luchazwa yisimiso se-selective photothermolysis. Endabeni yezinhlelo ze-laser ezithile zemithambo yegazi, okuhlosiwe yi-oxyhemoglobin yangaphakathi kwemithambo yegazi.
Ngokubhekisisa i-oxyhemoglobin, amandla adluliselwa odongeni lwemithambo oluzungezile. Njengamanje, i-laser engu-1064-nm Nd: YAG kanye namadivayisi okukhanya okubonakalayo/okuseduze kwe-infrared (IR) okunamandla okucindezela (IPL) womabili anikeza imiphumela emihle. Umehluko omkhulu, nokho, ukuthi ama-laser e-Nd: YAG angangena ngokujulile kakhulu futhi ngenxa yalokho afaneleka kakhulu ekwelapheni imithambo yegazi emikhulu, ejulile njengemithambo yemilenze. Enye inzuzo ye-laser ye-Nd: YAG ukuthi i-coefficient yayo yokumunca ephansi ye-melanin. Njengoba i-coefficient yokumunca ephansi ye-melanin, akukho ukukhathazeka okukhulu ngomonakalo we-collateral epidermal ngakho-ke ingasetshenziswa ngokuphephile ukwelapha iziguli ezinombala omnyama. Ingozi ye-hyper pigmentation ngemuva kokuvuvukala ingancishiswa kakhulu ngamadivayisi okupholisa e-epidermal. Ukupholisa i-epidermal kubalulekile ukuvikela ekulimaleni kwe-collateral okuvela ekumuncweni kwe-melanin.
Ukwelashwa ngemithambo yemilenze kungenye yezinqubo zobuhle ezivame ukucelwa. Ama-venule ajabulisayo atholakala cishe ku-40% wabesifazane kanye no-15% wabesilisa. Ngaphezu kuka-70% banomlando womndeni. Ngokuvamile, ukukhulelwa noma amanye amathonya ama-hormone ahilelekile. Nakuba kuyinkinga yobuhle ngokuyinhloko, ngaphezu kwengxenye yale mithambo ingaba izimpawu. Inethiwekhi yemithambo yegazi iyisimiso esiyinkimbinkimbi semithambo eminingi enezinga eliphezulu nokujula okuhlukene. Ukugeleza kwemithambo yemilenze kuqukethe imigudu emibili eyinhloko, i-plexus ejulile yemisipha kanye ne-plexus yesikhumba engaphezulu. Imigudu emibili ixhunywe yimithambo ejulile ebhobozayo. Imithambo yesikhumba emincane, ehlala ku-dermis ephezulu ye-papillary, igeleza iye emithanjeni ye-reticular ejulile. Imithambo ye-reticular emikhulu ihlala ku-dermis ye-reticular kanye namafutha angaphansi kwesikhumba. Imithambo ye-superficial ingaba mikhulu njenge-1 kuya ku-2 mm. Imithambo ye-reticular ingaba nobukhulu obuyi-4 kuya ku-6 mm. Imithambo emikhulu inezindonga ezijiyile, inegazi elikhishwe umoya-mpilo eliningi, futhi ingaba ngaphezu kuka-4 mm ukujula. Ukwehluka ngobukhulu bemithambo yegazi, ukujula, kanye ne-oxygenation kuthinta indlela yokusebenza kanye nokusebenza kahle kokwelashwa kwemithambo yemilenze. Amadivayisi okukhanya abonakalayo aqondisa iziqongo zokumuncwa kwe-oxyhemoglobin angase amukeleke ekwelapheni ama-telangiectasias angaphezulu kakhulu emilenzeni. Ama-laser amade, aseduze ne-IR avumela ukungena okujulile kwezicubu futhi angasetshenziswa ngisho nokubhekisa emithanjeni ejulile ye-reticular. Ama-wavelength amade nawo ashisa ngokulinganayo kunama-wavelength amafushane ane-coefficients ephezulu yokumuncwa.
Izindawo zokugcina zokwelashwa kwemithambo yemilenze nge-laser ukunyamalala kwemithambo yegazi ngokushesha noma ukuqhekeka kwemithambo yegazi okubonakalayo noma ukuqhekeka. I-Microthrombi ingase ibonakale ku-lumen yemithambo yegazi. Ngokufanayo, ukuphuma kwegazi okuphuma emithanjeni yegazi kungase kubonakale ngenxa yokuqhekeka kwemithambo yegazi. Ngezinye izikhathi, umsindo ozwakalayo ungase uzwakale ngokuqhekeka kwemithambo yegazi. Uma kusetshenziswa isikhathi esifushane kakhulu sokushaya kwenhliziyo, esingaphansi kwama-millisecond angu-20, kungase kwenzeke i-purpura enobukhulu obungamaphuzu. Lokhu kungenzeka ukuthi kungenxa yokushisa okusheshayo kwemithambo yegazi kanye nokuqhekeka kwemithambo yegazi.
Ukuguqulwa kwe-Nd: YAG okunobukhulu obuhlukahlukene bamachashazi (1-6 mm) kanye nokukhanya okuphezulu kuvumela ukususwa kwemithambo yegazi egxile ngomonakalo omncane wezicubu ezihambisanayo. Ukuhlolwa kwezokwelapha kubonise ukuthi ubude besikhathi sokushaya kwenhliziyo obuphakathi kwama-millisecond angu-40 no-60 bunikeza ukwelashwa okuhle kakhulu kwemithambo yemilenze.
Umphumela omubi ovame kakhulu wokwelashwa nge-laser kwemithambo yemilenze yi-post inflammatory hyper pigmentation. Lokhu kubonakala kakhulu ngezinhlobo zesikhumba ezimnyama, ukuchayeka elangeni, isikhathi esifushane sokushaya kwenhliziyo (<20 milliseconds), imithambo eqhumile, kanye nemithambo ekwakheka kwe-thrombus. Iyanyamalala ngokuhamba kwesikhathi, kodwa lokhu kungaba unyaka noma ngaphezulu kwezinye izimo. Uma ukushisa ngokweqile kulethwa ngokushelela okungafanele noma isikhathi sokushaya kwenhliziyo, kungase kulandele izilonda kanye nezibazi ezilandelayo.
Isikhathi sokuthunyelwe: Okthoba-31-2022