摘要
目的总结应用ＫＴＰ／ＹＡＧ双波长激光配合胸外科手术治疗肺癌的经验。方法１９９５年５月以来为４５例肺癌患者（周围型肺癌３９例，单侧肺转移癌４例，双肺转移癌２例，肿瘤直径１．４～５．７ｃｍ）行激光手术。应用进口ＫＴＰ／ＹＡＧ双波长激光治疗机，ＫＴＰ激光波长５３２ｎｍ，Ｎｄ∶ＹＡＧ激光波长１０６４ｎｍ。术中根据不同病灶及组织结构，分别选择１２～１５Ｗ的ＫＴＰ激光或３０～６０Ｗ的Ｎｄ∶ＹＡＧ激光对肺叶或肺段肿瘤进行分离切除，对转移浸润的肺门与纵隔淋巴结行凝固汽化治疗。结果４５例肺癌患者激光手术切除癌灶８３个，创面几无出血。手术出血量约１５０～２００ｍｌ。术后胸腔引流总血量５０～８０ｍｌ。１例因胸腔内残腔较大，拔管后第３天胸腔穿刺抽出２１０ｍｌ淡红色液体，其余病例无需胸腔穿刺抽液。胸腔引流管拔除时间为术后２０～２４ｈ。２０例患者术中肺鼓气检查示肺断面有不同程度肺泡漏气，用Ｎｄ∶ＹＡＧ激光补充照射融合肺泡后漏气停止，极少数残留小支气管未闭合者行结扎或缝合关闭，术后１周摄Ｘ线胸片未见气胸及肺不张征象。２例术后咳血痰２～３天，经对症治疗而愈。术后患者体温一般不超过３８℃。无并发症出现，临床疗效满意。结论术中激光的应用使肺组?
Objective To summarize the experience of chinical application of KTP/YAG dual wavelength laser systems in thoracic surgery of 45 cases patients with pulmonary carcinoma. Methods Since May 1995, 45 patients with pulmonary carcinoma (dimension from 1.4-5.7 cm) have been treated with laser systems, among them there are 39 cases of peripheral type, 4 cases of unilateral infiltrative type and 2 cases of bilateral infiltrative type. The KTP/YAG dual wavelength laser treatment system may be used at either the wavelength of 532 nm (KTP) or 1 064 nm (Nd∶YAG). According to the structures of various foci and lesions, two laser systems (12-15 W KTP or 30-60 W Nd∶YAG) were chosen to separate and excise the tumors in the pulmonary lobes and segments and to coagulate and vaporize the infiltrated and metastasis lymph glands in the hilum pulmoris and mediastinum. Results In this group of 45 cases with pulmonary carcinoma, 83 carcinomatous foci were excised by the laser treatment. The cut surface was almost bloodless. The operation bleeding was about 150-200 ml. The total blood volume of postoperative thoracic drainage was about 50-80 ml. Only in 1 case there was drainage of 210 ml slightly red liquid by thoracic puncture 3 days after removal of the drainage tube due to the thoracic residual cavity. No drainage of thoracic puncture was needed for the other cases. The removal time of the drainage tube was 20-24 hours after operation. The pulmonary inflation examination revealed 20 cases with various air leakage of the pulmonary alveoli from the pulmonary cut surface. Additional Nd∶YAG laser irradiation fused the pulmonary alveoli and stoped the air leakage. Suture and ligation were made for individual cases with opened residual small bronchus. X-ray check revealed no pneumatothorax and atelectasis one week after operation. There were 2 cases with bloody sputum for 2 to 3 days after operation, which were cured with appropriate treatment. The postoperative body temperature did not exceed 38℃ generally, with no complication. The overall therapeutic results in this group were satisfactory. Conclusions This method simplified the operation procedure and reduced the operation time. The application of laser treatment made the pulmonary cut surface closed without suture and made a minimal injury to the pulmonary tissues, increasing the precision of the operation and reducing the blood loss significantly.
出处
《中国激光医学杂志》
CAS
CSCD
1999年第1期30-32,共3页
Chinese Journal of Laser Medicine & Surgery
