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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 summarize the experience and experience in the application of semiconductor lasers in the treatment of intracranial tumors in microsurgery. METHODS: Of the 16 patients, 6 were meningiomas, 5 were gliomas, 3 were pituitary adenomas, and 2 were intraventricular ependymomas. The semiconductor laser wavelength is 810nm and the output power is 0-5 to 60W. Under a microscope, laser surgery was performed. The tumor capsule and surface were irradiated with 8 W laser light, and the capsule and surface blood vessels were shrunk and obliterated; the tumor tissue was cut and vaporized with a 15 W laser; the nerves and blood vessels adhering to the tumor were separated with an 8 to 10 W laser; 30 W laser cauterization, carbonization of the cerebral hernia or skull invaded by the tumor; 10-15 W laser cutting, vaporization of intraventricular tumors. Tumors invade the muscles and interstitial hyperthermia with 8 W lasers. Postoperative radiotherapy for patients with glioma. Results Of the 16 patients, 15 underwent total resection of the tumor. No relapse occurred after 6-30 months of follow-up. One case of meningioma was associated with intracranial and extracranial communication, invading the diaphragm and masseter muscles. It was unable to separate the masseter muscle adhesion and could not be removed completely. Hyperthermia, postoperative radiotherapy, and follow-up for 21 months without recurrence. Conclusion Under the operating microscope, the fiber of the semiconductor laser can reach the exposed brain tumor site. According to the need, different treatment modes can be used to rapidly coagulate, cut, and vaporize the diseased tissue and improve the tumor resection rate. It is worthy of clinical consideration for popularization and application.