本文選題：脈沖激光　切入點：減胎　出處：《浙江大學》2014年碩士論文　論文類型：學位論文

【摘要】：近年來,隨著輔助生育技術(shù)的發(fā)展,生殖科學在臨床實踐中獲得很大的成功。但是由于誘導排卵藥物以及輔助生殖技術(shù)的廣泛使用,在為許多不孕夫婦帶來希望的同時亦導致多胎妊娠發(fā)生率逐年提高。多胎妊娠會顯著增加孕產(chǎn)婦及胎兒的風險。為提高多胎妊娠中孕婦分娩的成功率,因此對于三胎以上的多胎妊娠,應(yīng)及時進行減胎術(shù),術(shù)后保留1-2個健康存活的胚胎,既可達到生育目的又可消除多胎妊娠導致的不良后果。目前常用的減胎方法需采用穿刺針機械刺入孕囊和胎心,會引起胎動,影響機械穿刺的精準度,而且這幾種方法均存在易感染、操作費時、手術(shù)難度高的問題。 隨著激光技術(shù)的發(fā)展與日漸成熟,利用高能量脈沖激光對胚胎進行減滅成為一種很有前景的減胎手術(shù)方法。因此,我們提出了一種全新的減胎手術(shù)的方法,即采用1064nm的脈沖激光直接聚焦于孕囊內(nèi)的胚胎內(nèi)部,通過激光作用于胚胎心臟部位產(chǎn)生的光學擊穿效應(yīng),對胚胎心臟造成損傷,使胚胎快速死亡,達到減胎的目的。該方法避免了機械針穿刺,且激光脈沖作用的時間非常短,為納秒量級,避免了胚胎被作用時的劇烈胎動及熱效應(yīng),很大程度上降低了減胎手術(shù)的難度,提高了手術(shù)的精準度,在輔助生殖領(lǐng)域具有很好的應(yīng)用前景。 本文首先基于激光與生物組織相互作用的機理和激光在水中及生物組織中的光學特性,對激光減胎進行理論分析,闡述了激光減胎過程中發(fā)生的光學擊穿效應(yīng)的基本原理；其次,建立激光減胎的理論模型,從沖擊波、空化和熱效應(yīng)等方面驗證激光減胎方法的安全性；再次,使用牛肌肉組織和豬脂肪組織進行生物實驗研究,得出激光參數(shù)與損傷尺寸的關(guān)系,優(yōu)化實驗中所使用的激光參數(shù)；利用高速相機和水聽器探究水環(huán)境下激光脈沖與組織相互作用的過程,得出損傷范圍與水層厚度以及激光脈沖等參數(shù)之間的關(guān)系；最后,利用ICR小鼠胚胎模擬臨床手術(shù),驗證激光減胎的實用性和可行性。
[Abstract]:In recent years, with the development of assisted reproductive technology, reproductive science has achieved a great success in clinical practice. However, due to the widespread use of ovulation induction drugs and assisted reproductive technology, at the same time bring hope to many infertile couples also lead to increased incidence of multiple pregnancy. Multiple pregnancy may increase the risk of maternal and fetal in order to improve the multiple pregnancy pregnancy success rate, so for more than three fetal multifetal pregnancy, timely fetal reduction, 1-2 healthy living embryos retained after the operation, can achieve the purpose of fertility adverse consequences and can eliminate multiple pregnancy caused. The commonly used methods of fetal reduction should be adopted the needle machine piercing the gestational sac and fetal heart, can cause fetal movement, the influence of mechanical puncture accuracy, and these methods are susceptible to infection, time-consuming operation, operation difficulty is high.
With the development of laser technology and the increasingly mature, the use of laser on embryo reduction becomes a promising method for fetal reduction pulsed high energy. Therefore, we propose a new method of reducing fetal surgery, which uses 1064nm pulse laser focus directly on the gestational sac in embryos, optical breakdown through the effect of laser in the embryonic heart parts, causing damage to the embryonic heart, make rapid embryonic death, to fetal reduction purposes. This method avoids the mechanical needle puncture, and the laser pulse time is very short, as nanoseconds, avoid violent movement when the embryo is effect and thermal effect, greatly reduce the fetal reduction operation, improve the operation accuracy and has good application prospect in the field of assisted reproduction.
Based on the optical properties and mechanism of laser tissue interactions in water and biological tissues, to analyze the theory of laser fetal reduction, describes the basic principle of the laser optical breakdown effect occurred in the process of the tire; secondly, a theoretical model of laser shock wave from fetal reduction, safety, cavitation verify laser and thermal effects of the methods of fetal reduction; thirdly, the use of bovine muscle and pig fat tissue in biological experiments, relationship between laser parameters and damage size, optimizing the laser parameters used in the experiments; using high speed camera and the inquiry process and hydrophone tissue interaction of laser pulse water environment, the the relationship between the damage range and layer thickness and the laser pulse parameters; finally, simulation of clinical surgery by using ICR laser mouse embryos, verify the practicality and fetal reduction Sex.

【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.8

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