摘要
目的 总结在显微外科应用半导体激光器治疗颅内肿瘤的经验和体会。方法 16 例患者中,脑膜瘤6 例,脑胶质瘤5 例,垂体腺瘤3 例,脑室内室管膜瘤2 例。半导体激光波长810nm ,输出功率0-5 ～60 W。显微镜下行激光手术,用8 W 激光照射肿瘤被膜和表面,使被膜和表面血管皱缩闭塞;用15 W 激光切割、汽化肿瘤组织;用8 ～10 W 激光分离与肿瘤粘连的神经和血管;用30 W 激光烧灼、炭化被肿瘤侵及的大脑镰或颅骨;用10 ～15 W 激光切割、汽化脑室内肿瘤。肿瘤侵及肌肉,用8 W 激光行间质热疗。脑胶质瘤患者术后加放疗。结果 16 例患者中15 例肿瘤全切除,随访6 ～30 个月无复发;1 例脑膜瘤颅内外相沟通,侵及眶和咬肌,与咬肌粘连无法分离,不能全切除,故行间质热疗,术后加放疗,随访21 个月无复发。结论 在手术显微镜下,半导体激光器的光纤可达到显露的脑肿瘤部位,可根据需要选用不同治疗模式迅速凝固、切割、汽化病变组织,提高肿瘤切除率,值得临床考虑推广应用。
Objective To report the experience of clinical therapy of diode laser in microneurosurgery to remove brain tumors in 16 cases. Methods There were 6 cases of meningioma, 7 cases of glioma and 3 cases of pituitary adenoma. A diode laser (Biomed) with the wavelength of 810 nm was used and its power output was in a range of 0 5-60 W. Non contact, contact or interstital irradiation were used during the operation procedure. We used 8 W laser to deal with the envelop and surface of the tumor to make their blood vessels shrunk or occluded, 15 W laser to cut and vaporize the tumor tissue, 8-10 W to separate the nerves and blood vessels from tumor tissue and 30 W to cauterize and carbonize the cerebral falx and skull that were invaded by tumor infiltration. As to the intra ventricular tumor, we used 10-15 W laser to cut and vapourize it and 8 W laser to deal with the tumor tissues invaded into the muscle. Results The tumors were totally removed in 15 cases and sub totally removed in 1 case due to that the tumor invaded both the orbit and masseter muscle and could not be separated from masseter muscle. We performed interstitial irradiation as well as post operative radiotherapy. Pathological examination showed it was a fibrous type meningioma and tumor cells grew actively. No recurrence of the tumor was observed at 21 months after operation and the patient was able to undertake field work. Conclusions Using the diode laser under microsurgery, brain tumors could well be exposed and rapidly coagulated, excised or vaporized. This method is easy to operate and safe, and may perfectly provide both coagulation and vaporization functions.
出处
《中国激光医学杂志》
CAS
CSCD
1999年第3期151-153,共3页
Chinese Journal of Laser Medicine & Surgery
