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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。
Objective To investigate the therapeutic effect of laser ablation laser sagger laser ablation on brain stem tumors. Methods A retrospective analysis of 23 patients with brain stem tumor admitted between March 2006 and May 2010 included 13 males and 10 females, aged 6 to 69 years old (average age, 41 years) with a duration of 14 ~ 36 months, an average of 22 months. The main symptoms of cranial nerve damage, cerebellar dysfunction and limb dysfunction. Both sapphire contact surgery laser knife brain stem tumor microsurgical resection, the use of conventional suboccipital incision, the dorsal approach to the brainstem, by local fine cutting and gastrotomy ablation of the tumor. Results All patients had glioma in 4 cases, cavernous hemangioma in 15 cases, hemangioblastoma in 2 cases and metastatic tumor in 2 cases. Total resection of the tumor in 15 cases, subtotal resection (removal of more than 80% of tumors) in 6 cases, the two total of 21 cases (91.3%). Less bleeding during surgery, intraoperative blood transfusions. The patients were followed up for 6 months, 15 cases were cured, 4 cases improved, 19 cases (82.6%) were two cases, no obvious change in 2 cases, 1 case aggravated, 1 case relapsed. No postoperative intracranial infection occurred, 2 cases were tracheotomy, the average length of stay 15d. Conclusion Contact laser knife easy operation, can be precisely cut and high temperature vaporized brain stem tumors, improve brain stem tumor resection rate, reduce bleeding and minor injuries, the treatment effect is good.