论文部分内容阅读
目的总结采用新型接触式Ｎｄ∶ＹＡＧ激光进行颅内肿瘤切除的临床效果。方法２８例患者中脑膜瘤１４例、星形细胞瘤５例、听神经瘤４例、颅咽管瘤和髓母细胞瘤各２例、室管膜瘤１例。Ｓｔｏｒｚ内镜下激光手术３例，显微镜下激光手术４例，直视下激光手术２１例。接触式Ｎｄ∶ＹＡＧ激光波长１０６４μｍ，输出功率０～１００Ｗ。瘤周分离用尖探头，激光功率５～１５Ｗ；瘤内汽化用圆探头，激光功率一般３０～６０Ｗ，脑室内２０～４０Ｗ。结果除１例中颅凹底脑膜瘤、１例蝶骨嵴脑膜瘤和１例丘脑星形细胞瘤作次全切除外，其余均行肿瘤全切除，肿瘤手术全切率为８９％。术中输血２００～１２００ｍｌ（中位数为６００ｍｌ）。无手术死亡病例。术后２例出现轻偏瘫，１例出现轻面瘫，１例低热，占１４％。结论接触式Ｎｄ∶ＹＡＧ激光用于颅内肿瘤，尤其是脑深部和重要功能区肿瘤的切除，可提高切除率，减少手术死亡率和后遗症，值得临床推广。
Objective To summarize the clinical effects of a new contact Nd:YAG laser for intracranial tumor resection. Methods 28 cases of meningiomas in 14 cases, astrocytoma in 5 cases, 4 cases of acoustic neuroma, craniopharyngiomas and medulloblastoma in 2 cases, 1 case of ependymoma. Storz underwent laser surgery under endoscopy in 3 cases, laser under the microscope in 4 cases, and under direct vision laser surgery in 21 cases. Contact Nd:YAG laser wavelength 1 064μm, output power 0 ~ 100W. Periparacentesis with a sharp probe, laser power 5 ~ 15W; intratumoral vaporization with a round probe, laser power is generally 30 ~ 60W, intraventricular 20 ~ 40W. Results Except for 1 case of submandibular meningioma, 1 case of sphenoid ridge meningioma and 1 case of thalamus astrocytoma, all cases underwent total tumor resection. The total surgical rate of tumor operation was 89%. Intraoperative blood transfusion 200 ~ 1200ml (median 600ml). No operative deaths. Mild hemiplegia occurred in 2 cases, light facial paralysis occurred in 1 case, and low fever in 1 case, accounting for 14%. Conclusion The contact Nd∶YAG laser can be used in the treatment of intracranial tumors, especially in the deep brain and important functional areas. It can increase the resection rate and reduce the operative mortality and sequelae. It is worthy of clinical promotion.