钬激光辅助治疗的咽部微创手术

目的 :探讨用钬激光辅助的微创手段治疗解剖位置较深 ,但又有自然通道的咽部良性肿瘤。方法 :14例术前诊断为咽部良性肿瘤患者 ,其中包括血管瘤 ,神经纤维瘤 ,乳头状瘤 ,淋巴组织。借助手术显微镜和内窥镜充分暴露位置较深的咽部肿瘤 ,用钬激光治疗咽部良性肿瘤。用Davis张口器暴露患者口咽部 ,若肿瘤暴露完整 ,则进行显微镜下处理 ;若肿瘤只能暴露部分 ,则口咽部用显微镜下处理 ,鼻咽部在内窥镜下处理。显微镜下精确肿瘤的边缘 ,分辨血管的走向 ,用钬激光烧灼 ,剥离子钝性分离 ,逐渐将肿瘤与周围正常组织分离。将内窥镜置于右侧鼻腔 ,探及鼻咽部。将钬激光发射光纤头从左侧鼻腔置入鼻咽部 ,内窥镜明视下在肿瘤周围烧灼 ,用镰状刀切开已烧灼创面粘膜 ,迅速钳取部分肿瘤留送病理检测。再用激光烧灼止血。结果 :手术中由于暴露充分 ,出血量较少 ,良性肿瘤能完整切除 ,未复发。结论 :利用各种显微、内窥镜手段能将解剖深部组织充分暴露 ,同时结合钬激光等器械能很好地处理肿瘤周围血管 ,能有效地、创伤极小地治疗咽部良性肿瘤

The Effect Of Ho:YAG Laser in Minimally Invasive Surgery in Pharyngeal Tumor

Objective:To evaluate Ho:YAG laser effect in minimally invasive surgery in the management of tumor in pharyngeal which is deep but have natural canal in anatomy. Methods:14 cases which were benign tumor in pharyngx: hemangioma, fibroma and papilloma, lymphangioma. Under the surgery microscope and endoscope, the tumors in pharynx were exposure completely. Ho:YAG laser were used to separate tissue. If endoscope was used to exposure tumor in nasopharynx, laser head was reached from another nasal cavity. With curve blade, the carbonizd tissue by laser was cut off. Results:All patients have good outcome. Conclusion:In term of operation time and blood losses, bipolar and laser with microscope and endoscope are comparable to routine surgery. It could treat the tumor in pharynx effectively and less lesion.