Method for treating excessive granulation tissue of larynx and trachea

FIELD: medicine, otorhinolaryngology.

SUBSTANCE: one should treat deformation in laryngeal and tracheal lumen due to excessive growth of granulation tissue in the sites of their lesions. One should introduce hormonal preparations, moreover, one should apply Diprosan as a hormonal preparation injected once intramucosally at 0.1 ml/sq. cm of granulation tissue, but not more than 0.3 ml.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

 

The invention relates to the eye and can be used in the treatment of excessive growth of granulation tissue of larynx and trachea with the aim of preventing the formation of chronic cicatricial stenosis of these bodies.

In most cases, trigger point in the formation of deformation of the lumen of the larynx and trachea is their injury when performing resuscitation. (Perelman M.I. Cicatricial stenosis of the trachea - prevention and treatment /Prevention, diagnosis and treatment of cicatricial stenosis of the trachea: proc. Dokl. - M., 1999. - P.3-4.)

The background condition of the body, joining immune disorders define the peculiarity of reparative processes in the larynx and trachea in the form of a tendency to heal by second intention with excessive growth of granulation tissue.

The constant formation of foci of granulation tissue with degenerative and metaplastic changes of the epithelium on the background related immunological disorders, diseases of the cardiovascular and respiratory systems lead to the formation of foci of chronic inflammation. (Ryabova M.A., Karpischenko S.A. Ermakov Vinblastin in the treatment of chronic cicatricial stenosis of the larynx // West. otorhinolaryngology. Proceedings of the Russian conference of otolaryngologists. - 2002. - S-332). The final formation of scar tissue occurs after an average of 8 months (Schechter A.B., Shuster AM Histomorphology and histochemistry acquired scars gartentrampolin Department in children. // West. Otorhinolaryngology. No. 5. - 1991. - P.52-55). It was during this time, there is a possibility of drug effects on excessive granulation tissue with the aim of reducing the indications for surgical excision of the scar tissue of the larynx and trachea.

Existing methods of surgical treatment of obstruction of the lumen of the larynx and trachea excessive granulation tissue are divided into various modifications excision her using traditional scalpel, ultrasonic scalpel and laser radiation. (Singer VG, Nasedkin an Experience of surgical treatment of children with Robovie stenosis of the larynx and trachea. // West. Otorhinolaryngology No.4. - 1991. - p.46-49).

The disadvantage of these methods is: increased invasiveness, prone to postoperative healing of the wound surface by a secondary tension with recurrent excessive growth of granulation tissue.

There are ways phased implementation hormone that reduces inflammation, following the way of immunoassay reducing excessive growth of granulation tissue, with hormonal drugs are used topically in the form of applications (Bondarenko E.A., lepekhina T.V. injuries of the larynx in children // Russian Torinla gology. No. 1. - 2002. - s-69). The disadvantage of this method is the duration of treatment, the need for repeated injection due to the short duration of their action (one day).

The closest analogue is the way (Rosen G., Vered I.Y. Triamcinolone Acetoide Injection for Laryngeal stenosis.// J.Laryng. - 1975. - Vol.89, N10. - P.1043-104) introduction under the control of indirect laryngoscopy of triamcinolone acetonide and methyl acetate prednisolone in combination with hyaluronidase through the skin into the area of excessive granulation tissue.

But the disadvantage of this method of hormone therapy is the need for long-term repeated exposure due to the intermittent action of the drug (up to 5 days). Low efficiency and low interest rehabilitation necessitates surgical excision of excess granulation tissue.

The objective of the invention is to increase the effectiveness of treatment of patients with excessive growth of granulation tissue in the larynx and trachea after their damage by injection of hormonal drug Diprospan (betamethasone sodium phosphate and betamethasone dipropionate) in the area of granulation tissue.

The task is as follows: during endoscopic direct and retrograde examination of the lumen of the larynx and trachea visualize the zone of deformation of the lumen due to excessive growth of granulation and f is bronnoy fabric, with the subsequent measurement of the area affected. Then determine the total area of the inner surface of the trachea and larynx, are involved in the pathological process, for example, by means of computer tomography indicate the decreasing cross-sectional area of the larynx trachea.

Patients with existing tracheostomy hole after application of anesthesia solution of 10% lidocaine once entered Diprospan at a rate of 0.1 ml per 1 cm, the maximum dose should not exceed 0.3 ml Patients without tracheostomy introduction of the drug is performed endoscopically in similar doses.

Diprospan - water prolonged form of betamethasone. Due to the two factions in its composition the effect of Diprospan begins after 2-4 h after injection (betamethasone disodium phosphate), and remains already due to the slow current faction (betamethasone dipropionate) and lasts for 3-6 months. The effectiveness of the proposed method was estimated by the frequency of re-growth of granulation tissue and destinazione the lumen of the larynx and trachea, which was estimated by repeated endoscopic examinations. Objective criterion was performance spirography. In this category of patients have obstructive type of violations ventilation due to increased aerodynamic resistance of the trachea. Recorded increased airiness of the lungs and an increase in functional residual capacity (I). After injection of the drug resistance to air flow is significantly decreased, which is reflected in the decrease of the indicators I.

Patients of the main group and the comparison group had a deformation of the lumen of the larynx and trachea due to excessive growth of granulation tissue with impaired respiratory function in obstructive type. Both groups were divided into three subgroups depending on the area of the pathological process. The best results were obtained in the main group in the area of excessive granulation 0.5 KVM - percent rehabilitation amounted to 92% with normalization of indices I. Only 3% was recorded recurrent excessive growth of granulation tissue. In the comparison group, these figures were, respectively, - rehabilitation of 78%, the relapse - 6%. When the involvement of the larger area of the larynx and trachea 1 cm, 2 cm, also recorded significantly better result indicators rehabilitation in the main group, see table. The advantage of the proposed method for the treatment of cicatricial stenosis of the larynx and trachea and prevent their recensione is that:

- reduced the severity of chronic inflammation in the larynx and trachea;

- accelerates the formation of enlightenment is and the larynx and trachea due to regression to the excessive growth of granulation tissue;

- reduced the number of relapses, destinazione the lumen of the larynx and trachea due to prolonged action of the drug;

- reduced the trauma patient management, by reducing the number of interventions in the prolonged component of the drug;

- reduced the number of patients requiring surgical excision of excess granulation tissue.

Example 1. The patient, male, age 37 years, no history 257, was admitted to the ENT Department 15.03.03 with a diagnosis of chronic cicatricial stenosis of the trachea, chronic carolinesiel. Up to the present appeals have repeatedly held attempts trachea followed by decanoate, but it was difficult because of recurrent growth of granulation tissue on the posterior wall of the trachea at the level of 3-4 rings. The area of the scar and granulation tissue was approximately 2 KVM I 3,5 HP Under local application anesthesia with lidocaine 10% completed biopsy, injection of diprospan of 0.3 ml In the study the biopsies revealed: in the mucous membrane of the trachea found thickening own plates due to the proliferation of granulation and scar tissue with inflammatory cell infiltrates consisting of lymphocytes, macrophages, PMN, plasma cells; areas of proliferation f is broblasts with the formation of new collagen fibers. In small vessels were found productive inflammatory cell reaction and, often, fibrinoid necrosis of their walls. Significant changes have multi ciliated epithelium - desquamation of it, the degradation of the basal membrane, infiltration of lymphocytes and neutrophils in the epithelial layer. Places revealed hyperplasia and squamous metaplasia of the stratified squamous epithelium. In cartilaginous tissue: marked degenerative changes of chondrocytes in the form of karyopyknosis and karyolysis, the formation of empty gaps, areas of fibrous tissue.

In the future, after the application of diprospan observed a reduction in the growth of granulation and scar tissue, restoration of the lumen of the trachea. 18.06.03 under endotracheal anesthesia produced plastic anterior wall of the trachea. During the control study in 4 months - lumen tracheal wide growth of granulation and scar tissue is not detected, the control spirogram normalization of the index I is 2.6 liters

Example 2. Patient R., 21, case history No. 2567, was admitted with complaints of difficulty in breathing. From the anamnesis it is known that the patient had been prolonged intubation within 7 days regarding traumatic brain injury. According to computed tomography of the trachea is marked narrowing of the trachea due to scar tissue at the level of 6 rings of the trachea. Su is giving the sectional area of the lumen of the trachea by 1/3 and the area of the scar changes over 3.2 cm 2. Histological examination of biopsy: in the mucous membrane of the trachea found foci of chronic inflammation with signs of cicatricial changes the actual mucous membrane, formation of granulation tissue, degenerative changes in the surface epithelium with acanthocytosis growths and lesions metaplasia. Celebrated productive inflammatory vasculitis, marked degenerative changes of chondrocytes with lots of fibrous cartilage. The indices I of 3.2 liters Under local application anesthesia during endoscopic examination produced around the scar tissue 0.3 ml of diprospan. At follow-up at 7 months. it was noted the disappearance of subjective complaints, the extension of the lumen of the trachea (the lumen was narrowed to 1/5) I 2.7 l, the reduction of the area of the scar to 1.5 cm2.

Example 3. Patient S., aged 77, No. history 1611, was treated in the ENT Department regarding chronic stenosis of the larynx and 2-sided paralysis of the larynx, rheumatoid arthritis. During laryngoscopy, the lumen of the glottis sharply narrowed due to immobility corporatewide joints. In the back commissure - scar spike with a total area of 1.5 cm2. I 3,8 L. Performed histological study found: inflammatory cell accumulation in the scar tissue expressed changes in the microcirculatory bed, the formation of granulation tissue, metaplastic epithelial changes, degenerative changes in the cartilage tissue. Produced by the injection of diprospan of 0.3 ml.

After 6 months: celebrated the restoration of mobility in corporatewide joints, reduction of the area of scar tissue to 0.6 cm2, I, 3.2-liter, breathing compensated. The patient was rehabilitated.

The method is simple to perform, requires no special training of staff, and can be used in the practice of ENT departments and departments of thoracic surgery of any hospital.

The method of treatment deformation of the lumen of the larynx and trachea due to excessive growth of granulation tissue in the places of their damage, consisting in the use of hormonal preparations, characterized in that as a hormonal drug use Diprospan entered once nutricionista at a rate of 0.1 ml per 1 cm2granulation tissue, but not more than 0.3 ml



 

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