KTP?Nd∶YAG532倍频激光手术适应证新领域及临床实践(一)
详细内容
作者：韩丽川，丛日昌，白玉，汪彩之]
【摘要】 目的：探讨观察KTP?Nd∶YAG532倍频激光治疗眼睑、睑缘的良性肿瘤的临床效果。方法：术者配戴专业防护眼镜，手持光纤对准肿物基底部与睑皮肤表面、睑缘持平，360°点接点连续汽化，使之基底部周边游离，然后用有齿镊夹住肿物顶端，用尖刀顺势切断中部与组织相连接部位。结果：手术部位平整，不留瘢痕，眼部正常组织结构无明显改变。结论：KTP?Nd∶YAG532倍频激光治疗眼睑、睑缘肿物安全、有效，开辟了倍频激光手术新的领域。
【关键词】 YAG532倍频激光；手术；新领域；临床实践
AbstractをAIM: To investigate the clinical results of KTP?Nd∶YAG532 SHG laser surgery no the benign tumor of eyelid and palpebral margin.METHODS: With surgeon wearing specialized protective glasses,handhelding fiber to the base of the tumor , continuous gasifying went to the tumor in 360° circle at the level of the eyelid skin surface and palpebral margin to make the tissue around the tumor dissociated, then the top tissue of the tumor was griped with the toothed forceps, and the parts in the central connected to the tumor were cut off.RESULTS: The surgical site skin was smooth, and no scar on them,and there were no significant changes in normal eye tissues.CONCLUSION: The treatment by KTP?Nd∶YAG532 SHG laser to cure the benign tomor of eyelid and palpebral margin is safe and effective. It is an new exploration of KTP?Nd∶YAG532 SHG laser surgery.
KEYWORDS: KTP?Nd∶YAG532 SHG laser; surgery; new effective technology means; clinical practice
0 引言
KTP?Nd∶YAG532倍频激光是治疗泪道疾病先进手术方法之一。近5a来，我们根据 KTP?Nd∶YAG532倍频激光的特性，有选择的放宽、扩大手术适应证，治疗如眼睑、睑缘的良性肿瘤累计病例232例，取得良好的效果，达到治疗目地。现总结如下。
1 对象和方法
1.1 对象
具有完整病历资料并经病理检查明确诊断病例232例，男198例，女34例。年龄3～72岁。其中乳头状瘤88例；赘疣41例；皮肤色素痣29例；黄色素瘤35例；炎性肉芽肿28例；眼睑表浅孤立小血管11例。
1.2 方法
手术均在门诊激光室进行（术前激光室常规紫外线空气消毒）。患者平卧位；术眼常规消毒铺巾；20g/L利多卡因肿物周边皮下局部浸润麻醉；激光器采用武汉化工激光工程有限责任公司生产的HGL?MYK8型KTP6激光。技术参数：激光介子：KTP/Nd∶YAG；激光波长：1064nm倍频532nm；最大输出功率（带光千）>8W；电源：（220±22）V。光纤直径0.4mm，功率控制在4～5W之间。术者配戴专业防护眼镜，手持光纤对准肿物基底部与睑皮肤表面、睑缘持平，360°点接点连续汽化，使之基底部周边游离，血管阻断，肿物萎缩变小，呈灰白色状。然后用有齿镊夹住肿物顶端，用尖刀顺势切断中部与组织相连接部位，也可根据肿物大小、位置、形态用组织剪剪除。切除后的肿物送病理。术中观察肿物是否切除干净，有无出血，创面是否平复，与周围组织外观上是否协调。如个别情况表面切除后少许渗血部位，可重复汽化点数止血。术毕不缝线，创面涂红霉素眼膏即可，无需纱块遮盖，少数病例遮盖1d。次日复诊常规换药、裂隙灯下观察创面干洁、平复、无残留。嘱患者不要用手搓揉手术部位，尤其手术部位在睑缘者，嘱自己点用抗生素滴眼液，激光部位表面每日涂红霉素眼膏至完全修复，一般完整修复时间在2～4d。