应用CO_2激光治疗口腔颌面疾病(附367例分析)

Experience of Oral-dentofacial Disease treated with CO_2 Laser for 367 Cases

目的 总结CO2 激光在口腔颌面外科疾病治疗上的应用。方法 本组 367例 ,男 198例 ,女 169例。年龄 4～ 70岁 ,疾病分类为阻生齿龈瓣覆盖 33例 ,舌系带过短 2 0例 ,粘液腺囊肿 82例 ,淋巴管瘤 14例 ,血管瘤 18例 ,牙龈瘤 5 4例 ,牙龈增生 4 3例 ,乳头状瘤 74例 ,痣、疣及角化棘皮瘤 2 9例。术区常规消毒 ,2 %利多卡因注射液浸润或阻滞麻醉后使用国产CO2 激光机 ,波长 10 6μm ,功率 0～ 30W连续可调 ,光斑直径 1～ 5mm ,对肿瘤或增生组织进行烧灼治疗 ,术后创面不缝合 ,涂布消炎药物 ,1～ 2周创口愈合。结果 367例病人 1次性治愈 2 73例 ,2次性治愈 81例 ,好转 13例 ,其中 8例后来改用手术治疗。随访 35 5例 ,治疗效果病人满意。结论 ①CO2 激光通过对组织进行烧灼 ,气化而产生热效应 ,使组织收缩、凝固、碳化封闭创面。手术视野清晰、出血少、损伤小 ,肿瘤切除彻底 ,复发少、手术时间短、反应轻 ,不感染 ,病人乐于接受。②OC2 激光在口腔颌面部疾病治疗上已得到广泛应用。③CO2 激光在治疗上有一定的局限性 ,肿瘤直径以不超过 1 5cm为宜 ,发生在颌面部者不宜超过 1 0cm ,深度不能超过皮肤真皮层 ,否则将会出现瘢痕。

Objective To summarize the application of CO2 laser in oral dentofacial surgical disease treatment. Methods The disease categories 367 cases of patients aged 4～70 year old (male 198 and female 169) were 33 cases of hinder gingival flap, 20 cases of ankyloglossia, 82 of mucosa gland cyst, 14 of lymphoma, 18 of angioma 54 of gingival tumor, 43 of gingival hyperplasia, 74 of papilloma and other 29 cases. The CO2 laser with wave 10.6um, 0～30 w continuously adjustment and 1 5mm in diameter of spot was used to burn the lesion without suture after local anesthesia with lidocaine. The wounds healed after 1～2 weeks. Results 273 patients were recovered one time and 81 cases were treated twice with good result 13 cases. 8 cases were received operation after laser treatment. All curative effects of 355 patients were satisfied after follow up. Conclusion The CO2 laser could burn and gasify the tissue to make it contract, coagulate, carbonize to close the wound. The operative area was clear and less bleeding and injury. This method had used widely and could remove the lesion completely and without relapse, less reaction, time of operation was short so that the patients could be easy to receive. But there was a limit for CO2 laser treatment that the tumor diameter should be less than 1.5cm and less than 1.0cm at facial part. The depth should not be reached dermic layer otherwise scar would be formed.