接触式激光刀在脑干肿瘤显微切除中的应用

摘要

Objective To explore the therapeutic efficacy of a new type sapphire contact laser using wavelength-shifting technique on microsurgery of brain stem tumors.Methods The clinical data were retrospectively analyzed of 23 patients (13 males and 10 females, aged 6 to 69 years with an average of 38 years, and the duration of disease was 14 to 36 months with average of 22 months) with brain stem tumor admitted from Mar.2006 to May 2010.The major symptoms of the patients were cranial nerve impairment, cerebellum function impairment or paralysis.All patients received microsurgical resection of brain stem tumor using sapphire contact laser through median suboccipital incision and posterior brain stem approach, and the tumors were resected with precision operation and vaporization and ablation.Results Of the 23 patients, 4 were with glioma, 15 with cavernous angioma, 2 with angioreticuloma and 2 with metastatic tumor.Total resection was achieved in 15 cases, while subtotal resection (more than 80％) in 6 cases.Intraoperative hemorrhage was less and no intraoperative blood transfusion was required.A 6-months follow-up showed symptoms recovered in 15 patients, improved in 4,unchanged in 2, and worsen in 1.One patient died of recurrence of tumor.No postoperative intracranial infection was occurred, and 2 patients ware undergone tracheotomy after operation.The average hospital stay was 15d.Conclusion The contact laser can precisely dissect and vaporize the tumors, increase the resection rote, reduce intraoperative hemorrhage and accessory injuries, and has a clear and definite effect.%目的 探讨应用激光波长转化技术的新型蓝宝石接触式激光刀显微切除脑干肿瘤的疗效.方法 回顾性分析2006年3月-2010年5月收治的脑干肿瘤患者23例,其中男13例,女10例,年龄6～69岁,平均38岁(中位年龄41岁),病程14～36个月,平均22个月.主要症状为颅神经受损,小脑功能障碍及肢体功能障碍等.均应用蓝宝石接触式手术激光刀行脑干肿瘤显微切除,采用常规枕下正中切口、脑干背侧入路,通过局部精细切割及气化消融切除肿瘤.结果 所有患者中胶质瘤4例,海绵状血管瘤15例,血管母细胞瘤2例,转移性肿瘤2例.肿瘤全切15例,次全切(切除80%以上肿瘤)6例,两者合计共21例(91.3%).手术过程中出血少,术中无输血.术后随访6个月,痊愈15例,好转4例,两项合计19例(82.6%),病情无明显变化2例,加重1例,复发死亡1例.术后无颅内感染发生,2例行气管切开,平均住院时间15d.结论 接触式激光刀操作便捷,可精确切割和高温汽化脑干肿瘤,提高脑干肿瘤切除率,减少出血及副损伤,治疗效果好.