Method for treating patients for nodal forms of thyroid gland diseases

FIELD: medicine.

SUBSTANCE: method involves carrying out instrumentally controlled intervention with high intensity laser radiation being supplied to thyroid gland node via light guide brought into thyroid gland node body with a conductor through soft tissues. Dynamic temperature control is carried out 0.2-0.7 cm laterally far from nodal form boundary as the instrumental control in performing laser radiation treatment. 37-40°C being reached, laser radiation treatment is to be stopped. Laser light guide is introduced into the thyroid gland node 2-3 cm far from conductor end.

EFFECT: enhanced effectiveness of non-invasive, organ-saving treatment without narcosis being applied.

2 cl

 

The invention relates to endocrinology, and is intended to optimize the treatment of nodular, mostly benign, thyroid gland formation of high-intensity laser exposure with temperature control at the border of pathological and healthy tissues.

There is a method of surgical treatment of nodular forms of diseases of the thyroid gland, which is the removal of pathological tissue acute way, i.e. by means of a scalpel (see Surgical endocrinology. Kalinin A.P., Maistrenko N.A., Vatchev P.F., ”Peter”, 2004, s-264).

The disadvantage of this method is the high invasiveness, the possibility of intra - and postoperative complications.

There is a method of treatment of the nodules of the thyroid gland, combining the dissection of soft tissues by acute and allocation of pathological tissue with the use of CO2laser (A.A. Martino and others Use laser operations on the thyroid gland. M.: problems of endocrinology, 1989, s-180).

The applied method of treatment is also traumatic and does not exclude the possibility of postoperative complications, involves the dissection of the soft tissues of the neck with the formation of a cosmetic defect and the use of anesthesia.

There is a method of treatment of the nodules of the thyroid gland, selected as a prototype, is with the intervention under instrumental control with the use of high-intensity laser radiation in the thyroid node using at least one optical fiber, puncture and aspiration delivered in thickness of a site guide through the soft tissue of the neck (Patent RF №2143933).

The method involves interference with the use of high-intensity laser radiation by punctional method through the soft tissue of the neck at the site of the thyroid gland under instrumental control. For the procedure uses high-intensity diode or neodimio lasers from 1 to 7 watts. The duration of exposure when using a diode laser varies from 60 to 450 and from 60 to 500 for neatimage laser. The intervention site is under instrumental (ultrasound) control that allows you to fix errors with the introduction of fiber to the node and enter the laser light source directly in his column.

The disadvantage is that this method gives only an approximate calculation of the time of laser irradiation and its power.

It is known that thermal effect of the laser radiation in the tissue depends on the absorption coefficient and Deposit energy of this cloth, which is determined by its optical and thermal properties, conductivity, intensity of circulation, etc. To achieve the maximum effect from the laser thermal radiation, taking into account all these properties of the tissue, it is necessary to identify the parameters that can be related objectively to trainout.

Thus, the object of the present invention is to provide an efficient method of monitoring the laser hyperthermia, which would most effectively be treated in one session and minimal trauma thermal exposure of healthy tissue.

This task is achieved by the fact that in the treatment of nodular forms of thyroid disease, including interference under instrumental control with the use of high-intensity laser radiation power from 2 to 6 watts per unit of the thyroid gland via the fiber, puncture and aspiration delivered in thickness of a site guide through the soft tissue, proposed as tool control during laser irradiation to perform dynamic registration of the temperature lies lateral to the border nodular 0.2-0.7 cm, and upon reaching values 37-40°With laser treatment to stop.

In addition, the proposed fiber laser to enter in the thyroid node next 2-3 mm of the end of the conductor.

Raising the temperature to 80°in the pathological area leads to coagulation and necrosis with subsequent scarring. When the heat tissue up to 37-40 degrees of irreversible changes are taking place. Controlling the temperature in the healthy zone, you can choose the optimal time of exposure, using a relatively harmless to the high power laser radiation (mostly 5-6 watts).

The method is as follows.

After pre-anaesthetic skin 2-3 ml of novocaine under instrumental control by using the apparatus for ultrasound in thickness nodules injected needle 19 G needle, through which shipping fiber optic light guide 2-3 mm then its end.

To achieve maximum effect from the laser irradiation end the end of the fiber should be cleaned from the polymer surface.

Needle during the session is removed from the node, which allows to simplify the method and to provide a “dry” field. Before the procedure, the liquid contents of the node maximum evacuated, thereby increasing the effectiveness of treatment.

Through the second puncture needle G 19 under the control of the ultrasonic observation unit mounted temperature sensor 2-7 mm lies lateral to the border of the nodules. Under the impact of high-intensity laser radiation inside the tissue site. Used a diode laser with a wavelength of 810 nm infrared light, operating in continuous mode and with power at the end of the optical fiber 5-6 watts. Irreversible tissue destruction occurs when the local heating to 80 degrees, which can be achieved in different volume and density of nodes, the man who pulirula the laser exposure time. When the local heating of the site, especially during continuous irradiation, part of the heat flow is diverted into the surrounding tissue. Heating up to 37-40 degrees does not involve irreversible structural changes, therefore, the session of laser radiation continues until it reaches the control area specified temperature. Control of the temperature gradient pathological and healthy zones allows to achieve an optimal effect of heating in the site without damaging the intact zone.

The method is illustrated by examples.

Example 1.

Patient M., born in 1961 Diagnosis: Nodular cystic modified goiter 111 Art. established on the basis of data from the ultrasound scan of the thyroid gland, core needle biopsy. When the puncture site received approximately 5.0 ml of cystic fluid brown on cytologic conclusion - nodular goiter with cystic degeneration. After local anesthesia with 2 ml of novocaine over the area of the proposed interventions under the control of the ultrasonic imaging apparatus in thickness nodules through a needle G19 held the light guide. The end of the fiber is located next 2-3 mm of the end of the needle so as to protect it from overheating, and well to control the location of the fiber, which during the session in the form of a bright luminous spots visible on the monitor screen of the ultrasonic device. Through the second needle G19 centuries the den sensor and installed under ultrasound control at 0.5 cm lies lateral to the border of the nodules. Conducted a session of laser treatment diode laser “Lotus 810-15”, having a wavelength of 810 nm infrared light, operating in the continuous mode with power at the end of the fiber 6 watts. The session lasted 5 minutes before reading to reach the sensor 37 degrees. Subjective feeling is minimal. Within 7 days in the area of laser irradiation there was pain without the reaction temperature. After a month there is a tendency to reduce the volume of the node, after six months on the spot nodules visualized by ultrasound hypoechoic area without clear boundaries, as a percentage amounting to 1/10 of the original volume. During the physical examination of the patient through 10 months of the thyroid gland had several heterogeneous structure without nodules.

Example 2.

Patient 3., 1987 born in D-3: Follicular adenoma. Diagnosis was confirmed by clinical and instrumental and cytological data. After pre-anaesthetic skin under ultrasound control node through a needle G19 entered the light guide on the next 2-3 mm needle tip, 5 mm lies lateral to the border node through a needle of the installed sensor. Conducted a session of laser irradiation device “Lotus 810-15 in continuous mode power 6 W for 6 min before reaching the readings of the temperature sensor 37 degrees. The subject of the passive sensations were noted. The tendency to reduce site has been 2-3 weeks. The distinct effect of laser treatment was six months: the physical control of the thyroid gland of the patient nodules does not contain, for ultrasonic testing has hypoechoic area without clear boundaries, component 1/10 of the original volume.

Example 3.

Patient K., born in 1965 D-C: Nodular euthyroid goiter 111 Art. with cystic degeneration. Diagnosed based on clinical, instrumental and cytological data. When core needle biopsy received 10 ml of cystic fluid brown on cytologic conclusion : cystic goiter. After local anesthesia with 2 ml of novocaine under ultrasound guidance through a needle G19 after preliminary evacuation of the cystic content entered disposable quartz light guide 2-3 mm beyond end of the needle. Through the second needle 5 mm lies lateral to the border node has thermosensor. Conducted a session of laser irradiation device “Lotus 810-15 in continuous mode power 6 watts. a wavelength of 810 nm within 5 min 30 sec. To achieve the readings of the temperature sensor 37 degrees. Subjective sensations were absent. Within 7-8 days in the area of impact has been little soreness. The tendency to decrease was observed after 1 month. A distinct decrease of the node is Pradelles by the end of 4 months, but at the nodal education there was an accumulation of cystic content of about 1.5 ml, they multi - core large cells, fibroblasts, signs of productive inflammation. The patient underwent a second session of laser irradiation by the same method, but with a duration of 3 minutes Noticeable effect of the treatment was 3 months: during the physical examination of the thyroid gland nodes does not contain, an ultrasound visible area of reduced echogenicity without clear boundaries, component 1/10 of the original volume.

Using this technique (apparatus laser radiation “Lotus 810-15, with a power of 6 W at the end of the fiber-optic waveguide, operating in the continuous mode with a wavelength of 810 nm in the infrared range) were treated 26 patients with benign and cancer nodular thyroid gland. The exposure time was determined by monitoring the temperature gradient at the boundary of pathological and healthy tissue. In all cases, within six months after the laser hyperthermia observed the formation of the scar, the size of which does not exceed 10% of the initial volume of the pathological tissue.

The proposed method is less traumatic, because puncture method, organ and is not intended to be the proposal trauma of healthy tissue aesthetic, because it leaves no effects of the intervention; not intended voltage psycho-emotional status of the patient; advantageous from the economic perspective, as is done in the outpatient setting, without the use of anesthesia, with a minimum time of treatment. So, are solved simultaneously ethical, psychosomatic and socio-economic objectives.

1. Treatment of nodular forms of thyroid disease, including interference under instrumental control with the use of high-intensity laser radiation in the thyroid node fiber, puncture and aspiration delivered in thickness of a site guide through the soft tissue, characterized in that as a tool of control during laser exposure perform dynamic registration of the temperature lies lateral to the border nodular 0.2-0.7 cm, and upon reaching values 37-40°With laser treatment stop.

2. The method according to claim 1, characterized in that the fiber laser is injected into the thyroid node next 2-3 mm of the end of the conductor.



 

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