Method for preventing lymphorrhea after radical mastectomy in patients with mammary cancer

FIELD: medicine, oncology.

SUBSTANCE: one should perform laser treatment for the surface of intercostals muscles and tissues in subclavicular and axillary areas at the distance of 4-6 mm against the wound, replace light guide's emitter with circular and liner-reciprocating movements, affect with focused laser beam at wave length being 1.06 mcm, at output power of 10-25 W, diameter of laser spot being 5 mm for 2-8 sec depending upon the dose of irradiation and power density. The method enables to decrease the volume of postoperational lymphorrhea and prevent the development of postoperational infectious complications.

EFFECT: higher accuracy and efficiency.

1 dwg, 1 ex, 1 tbl

 

The invention relates to medicine, namely Oncology.

In the structure of oncological morbidity of the female population of Russia of breast cancer is on the first place, and amounted in 2001 to 19.3%.

The prospect of improving treatment outcomes of breast cancer patients is associated with earlier detection of breast cancer and improving methods combined and complex treatment. Despite the development and improvement of methods of radiation therapy, production and introduction into clinical practice of effective hormonal drugs and surgical treatment of breast cancer patients remains dominant. Although revised in relation to the way to organ-saving operations in the direction of increasing the frequency of their execution, radical mastectomy in its various guises remains the operation of choice. Technical details of the operation are well developed, but, as with any other surgery, radical mastectomy is associated with a number of postoperative complications, largely determine the immediate results of the operation and further treatment[1, 3, 5, 6, 8, 9, 10, 11].

Radical mastectomy involves the removal of a significant mass of tissue, the intersection and wounding a large number of small blood and lymphatic vessels, which are often not tied during OPE the purpose, as visually in the tissues are not differentiated. Removing underarm-subscapularis-subclavian tissue with lymph nodes leads into the vast size of the wound cavity continues to enter the tissue fluid of the lymphatic network of the upper limb, as well as from lateral and posterior thoracic and partially abdominal wall. In addition, in the wound cavity flows out of tissue fluid from the intercostal lymph vessels from the surrounding soft tissues, in which the phase of hydration observed swelling and increased interstitial pressure. Rich lymphorrhea and the formation of seromas in 60% of cases leads to suppuration. Also the cause of suppuration is the maceration of the wound edges, which is a consequence of the abundant imparai and oozing through the seams. Known therapeutic activities: remote handling seams, correction of biochemical disorders of protein drugs and aldosterone antagonists, active drainage of surgical wounds with the use of various mechanical suction aimed at preventing prolonged and abundant imparai, are still insufficient, and lymphorrhea remains an actual problem.

Widespread in Oncology, received the lasers. It is known the use of laser for the treatment of both superficial tumors, t is K and tumors of internal organs [2, 4, 7]. However, to prevent imparai after radical mastectomy high-energy laser is not used.

For high-energy laser radiation is characterized by a local increase in pressure and temperature, and to low-energy radiation exposure is the development of photovoltaic and photochemical processes in biological objects. To obtain the effect of coagulation of tissue requires a lot of power laser radiation, and impact on intracellular biochemical processes enough to use radiation of low power. In surgery uses high-energy lasers, their action - cutting and coagulation of tissue. With the aid of laser radiation can destroy any tumor histological structure and size. The effect on the tumor can be performed as defocused beam - laser irradiation, and focused - laser coagulation [2].

The effectiveness of laser exposure is determined by mode of exposure, which is characterized by a power density, dose and time of exposure. Changing the values of these parameters, you can modify the intensity of laser irradiation, its depth. This is especially important when exposed to the wound surface to coagulate only the top layer of the wound.

In the available literature does not neid who have information about the effects of the laser on wound surface to prevent abundant of postoperative imparai in patients with breast cancer.

The objective of the invention is the prevention abundant of postoperative imparai and reduction of terms of treatment by exposure to a focused laser beam diameter of 5 mm, a wavelength of 1.06 μm output power laser tube 10-25 watts for 2-8 seconds, causing microcoagulation lymphatic vessels and their obliteration.

The task is carried out as follows. Remove the breast with axillary, subscapularis, subclavian tissue and lymph nodes. Conduct laser surface treatment of intercostal muscles and tissues of the subclavian and axillary region. Careful follow when processing tissue near the subclavian vein in order to avoid injuries.

The laser processing is conducted remotely focused beam diameter of 5 mm, While reducing the laser spot is less than 5 mm, the impact on the fabric takes on the character of the cutting. We use a surgical laser, for example: “Weasel” is a wavelength of 1.06 μm, a maximum output power of 100 watts. The continuous interaction of laser radiation with wavelength of 1.06 μm with biological tissue is predominantly thermal in nature. Laser treatment is carried out by moving the emitter fiber circular and linear reciprocating motion to cover the entire area of the wound surface. Emitting surface of the light the water feature at a distance of 4-6 mm from the surface of the wound, in order to keep the diameter of the laser spot 5 mm Coagulation laser conduct within 2-8 seconds depending on the power density and the exposure dose.

For effective laser treatment it is necessary to choose the exposure mode, which is characterized by a power density, dose and time of exposure.

The power density is the amount of power per 1 cm2the surface of the irradiated object. It is determined by the formula

where N is the power density; Po(W) - output power laser tube; S (cm2- the area of the laser spot.

Knowing the output power of the laser tube 10 W, 15 W, 25 W and the area of the laser spot 5 mm, we obtained a power density of 40, 60 and 100 W/cm2.

Dose - the amount of light energy that is needed to apply on 1 cm2wound surface to obtain a clinical effect, i.e. the impact on the wound surface to a depth of not more than 2 mm, the dose should be 200 - 300 j/cm2.

The exposure time is the time during which it is necessary to irradiate the tissue to obtain a clinical effect. The exposure time is determined by the formula

where W is the radiation dose; N is the power density.

It is known that for every 100 j/cm2to the s of irradiation, the depth of tissue damage is 1 mm. We found that for the prevention of imparai enough to affect the depth of the wound surface is not more than 2 mm when the diameter of the focused beam of 5 mm, so as not to damage the underlying tissue.

Table 1.

The timing of the exposure (s)required for treatment of the wound surface of the focused laser beam diameter 5 mm
The source dataPower density (W/cm2)Irradiation dose (j/cm2)Time exposure (C)
Output power of laser tube 10 watts. The diameter of the focused beam 5 mm40200-3005-8
The output power of the laser tube 15 watts. The diameter of the focused beam 5 mm60200-3003-4
Output power laser tube 25 watts. The diameter of the focused beam 5 mm100200-3002-3

Thus, depending on the output power of the laser tube when the diameter of the focused laser beam 5 mm determine the power density of the flow and the required time of exposure to the wound.

To assess the effect of the use of laser photocoagulation operating R is HN we have conducted a comparative analysis of the volume of imparai in patients with breast cancer operated by the proposed method, i.e. with the processing of the wound surface by the laser without the use of a laser. The study included 77 patients with breast cancer. 37 patients after radical mastectomy during the operation spent processing the wound surface by the laser on the proposed modes. The control group, 40 patients operated without the influence of the laser on the wound surface. Patients were comparable with the first group according to age, stage of disease, body weight and received neoadjuvant treatment.

By the end of the first day after surgery in patients operated by the proposed method (1), the amount of discharge of drainage from the surgical wound has averaged 190 ml compared with patients (2nd group) operated without the use of laser - 270 mil To 3 days after surgery, this indicator was equal respectively 165 and 230 ml. of 10 days after surgery in the first group the amount of imparai on average decreased to 45 ml. To this day the drains were removed in 29 of the 37 patients (78,4±6,8%). While in the second group, the amount of discharge of drainage averaged 120 ml. Drainage was removed only 7 of the 40 patients (17,5±6,0%). These were patients whose amount of imparai was per day of less than 50 ml at discharge from hospital (16-18 days after surgery) in the first group, the drainage was compa is in 33 of 37 patients (88,9± 5,2%), while the second group 18 of 40 patients (45,0±7,8%). The differences between the two groups is statistically significant (P<0,05).

Thus, the influence of high-energy laser on wound surface for the prevention of postoperative imparai is based on the fact that the laser radiation is called microcoagulation lymphatic vessels, their obliteration, which contributes to a significant reduction of imparai. 10 days after surgery in the first group using a laser volume imparai on average decreased to 45 ml, the drains were removed in 29 of the 37 patients in the control group, the volume of discharge to drainage averaged 120 ml, the drainage was removed only 7 of the 40 patients. By the time of discharge from the hospital on the 16th day after the operation, in the first group, the drainage was removed in 33 of 37 patients in the second group 18 of 40 patients.

Example 1. Patient B. 60 years, cancer of the right breast, the nodular form, IIB T2N1M0 Art. Performed surgery with radical mastectomy for Madden with the processing of the wound surface by focused laser beam with a wavelength of 1.06 μm, the output power of 25 W, diameter of laser spot 5 mm, the dose of 200-300 j/cm2within 2-3 seconds. Progress - horizontal access cut the skin, subcutaneous tissue with a surgical scalpel. The skin flaps useprivacy to the standard boundaries. Mo is full of iron removed as a single unit with axillary, subclavian, subscapularis tissue and lymph nodes. Next coagulare laser the entire wound surface, including the space between the major and minor pectoral muscles. Processing laser have remotely, at a distance of 4-6 mm from the wound surface by moving the emitter fiber circular and linear translational movement, focused beam diameter of the laser spot 5 mm, the output power of the laser tube 25 watt, treating each area of laser irradiation in 2-3 seconds. Drainage armpit. Wound closure. At 1 day after surgery, the patient drainage evacuated 200 ml of serosanguineous discharge, over 3 days - 160 ml, in 5 days - 100 ml, in 10 days - 50 ml, which allowed us to remove the drain. Later postoperative period, the patient was uneventful. Postoperative rehabilitation the patient was 10 days, instead of the usual 16 days.

The use of high-energy laser in the mode of coagulation in the processing of wounds in patients with breast cancer to reduce the amount of postoperative imparai and prevent the development of postoperative infectious complications. Proposed modes of laser coagulation can effectively solve this problem. Reduced postoperative rehabilitation patient 6 on the her and the earliest possible beginning of a special chemotherapy or radiation treatment.

References

1. Barsky, A.V. Application of vacuum dewatering and rehabilitation of patients after mastectomy for cancer / Barsky V., Golub A.I // New technical solutions in Oncology. - Kuibyshev, 1981. - Page 11-12.

2. Leschinskaya, MA Application of lasers in medicine / Leschinskaya MA, Alexandrov M. // Bulletin of talking. - 1985. No. 5. - P.65-70.

3. Voltaire, IS Active drainage of the wound after radical mastectomy performed in terms of combined treatment / Voltaire LS // Application of physical methods of treatment in clinical Oncology. - M.: Medicine, 1984. - P.35-37.

4. The loan, NF Lasers in experiment and clinic / loan NF - M.: Medicine, 1972. - 231 S.

5. Gerasimenko, V. The principles of restorative treatment of cancer patients / Gerasimenko V.N., Artyushenko Y. // J. struct. Vsesojuz. proc. “Improved methods of rehabilitation of cancer patients”. - L., 1978. - P.30-31.

6. Demin, NR. The breast cancer treatment / V. Demin. // Surgery. - 1977. No. 2. - P.23-26.

7. Dolganov, E.E. Experience 10 years the use of laser apparatus in operative endoscopy in the cancer patients / Dolganov E.E., Vaarala, Melstone // Oncology. - 2003. - V.49, no. 2. - S-188.

8. Levin, S.A. Postmastectomy edema of the upper limb, its causes, classification, prevention, treatment / Levin S.A., butchers is O, Gorbunov N. // Problems of Oncology. - 1987, No. 10. - P.106.

9. Lugovskoy, E.A. drainage of the wound after mastectomy / TD > E.A., Y.M. Timofeyev // Oncology. - 1981. No. 10. - P.85-86.

10. Medical rehabilitation of patients with cancer of the mammary glands / Melnikov R.A., Sharapova NA, Semiglazov SCI and other problems of Oncology. - 1981. No. 7. - P.77-82.

11. Sviatohina, O. Surgical treatment of breast cancer / Sviatohina O.V., Vishnyakova VV // Surgery. - 1978. No. 11. - S-112.

The way to prevent imparai after radical mastectomy in patients with breast cancer by drainage, characterized in that conduct laser surface treatment of intercostal muscles and tissues of the subclavian and axillary remotely at a distance of 4-6 mm from the wound, moving the emitter fiber circular and linear translational movement, focused laser beam with a wavelength of 1.06 μm output power 10-25 W, diameter of laser spot 5 mm, within 2-8 ° C depending on the fluence and power density.



 

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