Method of treating benign neoplasms of larynx

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to otolaryngology, and can be applied in treatment of benign neoplasms of larynx. method consists in surgical treatment with application of photodynamic therapy (PDT), which includes introduction of photosensitiser into patient's organism with further laser irradiation of neoplasm zone. Intubation of patient with endotracheal tube with inflatable cuff on end is carried out. Detachable reflector, facing the side of lower surface of vocal folds, is installed into endotracheal tube in lower part of larynx between vocal folds and inflatable cuff at 50-80° towards trachea side. Additional irradiation of lower part of larynx, including lower surface of vocal folds, is carried out simultaneously by reflected laser irradiation by means of reflector. Duration of photodynamic therapy session constitutes on average 600 s, with irradiation power being 1.5 W.

EFFECT: application of claimed invention makes it possible to increase treatment efficiency due to possibility of irradiation of lower part of larynx and lower surface of vocal folds, reduce terms of treatment of benign larynx diseases by carrying out a single PDT session.

3 ex

 

The invention relates to medicine and is intended for the treatment of benign tumors of the larynx.

The use of photodynamic therapy (PDT) for the treatment of benign and premalignant tumors is a very promising modern direction, see, e.g., "Photodynamic therapy and the treatment of neoplastic diseases of the larynx", Minneapolis Ear, Nose and Throat Clinic, MN 55404, http://www.ncbi.nlm.nih.gov/pubmed/17880501.

Known methods of treatment of benign tumors of the larynx, in particular, hyperplastic laryngitis by photodynamic therapy - laser irradiation with a wavelength of 675 μm with a capacity of 17 mW within 10 minutes of the affected area of the larynx. For irradiation using a nozzle-fiber diffuser. When this is injected photosensitizer is a cationic phthalocyanine for 2 minutes by an ultrasonic nebulizer. Just spend 10 sessions, EN 2361633 C2 (example 4).

The disadvantage of this method is the fact that irradiated mainly the upper part of the larynx and the upper surface of the vocal folds. Irradiation of the lower section of the larynx is very difficult, and irradiating the bottom surface of the vocal folds, practically, impossible. These circumstances cause a lack of effectiveness of the treatment, which is not compensated even a tenfold repetition of PDT.

Known is the method of treatment of benign tumors of the larynx, namely viral papillomatosis of the larynx, including surgical treatment is removal of the affected area followed by the application of PDT, including the introduction into a patient of a photosensitizer followed by laser irradiation zone neoplasms with a wavelength of 635 nm and energy density of radiation 50-100 j/cm2, EN 2194548.

This method is adopted as the prototype of the claimed invention.

The method according to EN 2194548 does not provide sufficient intensity of irradiation of the lower section of the larynx, which reduces the efficiency of PDT. In this regard, spend up to 5 or more sessions of PDT, which significantly increases the duration of treatment in General. So, in the description of the prototype method, example 2, it is noted that the patient had lesions in the middle and in the lower sections of the larynx, it took 5 sessions of PDT with an interval of 1.5-3.0 months.

The present invention is to improve the efficiency and shortening the treatment of benign diseases of the larynx.

According to the invention in the treatment of benign tumors of the larynx, including surgical treatment followed by the application of photodynamic therapy, including introduction into a patient of a photosensitizer followed by laser irradiation zone neoplasms, perform the intubation of the patient, the endotracheal tube with an inflatable cuff at the distal end, in the lower part of the larynx between the vocal folds and the inflatable cuff on the endotracheal tube install removable reflector facing the reflecting surface towards the lower surface of the vocal folds, which takes place simultaneously additional exposure to the lower part of the larynx, including the lower surface of the vocal folds, the reflected laser radiation.

The claimed method is implemented as follows.

Surgically remove the pathologic lesion in the affected area of the skin tag, hyperplastic portion of the mucous membrane, including, with patches of keratosis, and so on, followed by a session of PDT, at the same time for 1.5-2 hours before the session into a patient injected photosensitizer, in the specific example, photoditazine in the dosage of 1 mg per 1 kg of patient's weight. For the session of PDT when performing direct support micro laryngoscopy under the control of the operating microscope with a 4x-6andfold magnification using an operating laryngoscope Parsons or thin operating laryngoscope Benjamin removable illuminator for proximal illumination. The treatment is performed under endotracheal anesthesia with intubation through the mouth of an endotracheal tube with an inflatable cuff at the distal end. In the lower part of the larynx between voice warehouse is AMI and inflatable cuff on an endotracheal tube is placed under an angle of 50 to 80° in the direction of the trachea removable reflector, facing the reflecting surface towards the lower surface of the vocal folds. In a specific example, a removable reflector has a concave cylindrical back surface, the radius of which corresponds to a radius of the cross-section of an endotracheal tube. After installing removable reflector in the laryngoscope injected laser light guide and fix it so that the slice of the laser fiber was at a distance of 20-40 mm from the vocal folds. Then include a laser emitter that is connected to the light guide, and conduct a session of PDT. Laser beams coming out of the cut fiber, simultaneously irradiated as the upper and middle sections of the larynx and reflected from the removable reflector light the bottom surface of the vocal folds. The power density of the reflected laser radiation is 38-44% of this figure for the upper section of the larynx.

The duration of the session of PDT is on average 600 C at a radiation power of 1.5 watts.

The implementation of the hallmarks provides the technical result consists in the possibility of simultaneous irradiation of the upper section of the larynx and the lower section of the reflected light. This greatly increases the effectiveness of the treatment, since, as a rule, allows to do only one session of PDT.

Example 1.

Patient R., born in 1970, I. B. No. 14951, was nestacionarnog treatment in the ENT Department of the Mariinsky hospital with 29.03.10 on 15.04.10, diagnosed with juvenile papillomatosis of the larynx, recurrent form. From the anamnesis it is seen that hurts 5 years. Has undergone more than 20 surgeries over papillomatosis of the larynx. In the last 5 years are annual surgical intervention to remove skin tags.

08.04.10) underwent surgical treatment: made direct reference microlaryngoscopy, the removal of papillomas of the larynx.

During the operation revealed: on the background of a rough scarring of the mucosa of the vestibular division of the larynx, the vocal folds are multiple papillomas, occupying the whole of the vestibular and vocal departments of the larynx with the spread on the lower surface of the vocal folds.

After removal of papillomas during the operation completed session photodynamic treatment.

Dose entered sensitizer (photoditazine) was 1.2 mg per 1 kg of body weight, the dose of light energy 300 j on the irradiated field (exposure time of 12 minutes, the radiation power of 1.3 watts). Was exposed to the upper part of the larynx, and the lower part of the larynx using a removable reflector. The postoperative period was without complications. Within 12 days - vnutrigornye infusion, improved voice function was noted after 7 days on the background reduce swelling of the mucous membrane of the larynx.

Histological study No. 13505-14: squamous cell papilloma with the fragm the Tami stratified squamous epithelium, with symptoms of Hyper - and parakeratosis, without the underlying tissue, fragments of stratified squamous epithelium, with the phenomena of parakeratosis, the underlying fibrous tissue, with a single glands and moderate leukocyte infiltration.

Later in the course of the disease is marked remission to date.

Example 2.

Patient L., 55, and/b ID 11724, was treated in the ENT Department of the Mariinsky hospital 11.03.2010 on 18.03.2010 with a diagnosis of Chronic hyperplastic laryngitis. Keratosis vocal cords. Enrolled in a planned manner with complaints of hoarseness, fatigue voices.

Underwent surgical treatment is a direct reference microlaryngoscopy, deepithelization left and right vocal cords and PDT under endotracheal anesthesia. Dose entered sensitizer (photoditazine) was 1.2 mg per 1 kg of body weight, the dose of light energy 300 j on the irradiated field (exposure time 10 minutes, the radiation power of 2 watts). Along with the irradiation of the upper section of the larynx was performed irradiation of the lower section of the larynx using a removable reflector.

In the postoperative period on the first day, the patient complained of moderate pain in the throat, increased osobnosti also mentioned the deterioration of speech when subjective evaluation sonorous voice system GRBAS. According to the computerized acoustic analysis of voice in what was to increase jitter, shimmer, the reduction ratio of signal to noise. If individualincome was determined edema, hyperemia operated vocal fold and marked swelling of the surrounding mucous membrane of the larynx, when videolaryngoscopy - asymmetry and irregular fluctuations due to a significant reduction in the amplitude and frequency of oscillations operated vocal fold. Shortness of breath was not. In the postoperative period, the patient complies with the voice-activated mode; a course vnutripartiynyh infusions, 2 weeks theopedia.

The gradual improvement of speech according to subjective and objective evaluation noted 2 weeks amid reduce swelling of the mucous membrane of the larynx and improve the vibratory cycle of the vocal folds.

When viewed through 4 months voice has improved significantly, the mucosa of the larynx pink, vocal fold gray, smooth. There are signs hypotenuse disphonia - according to laryngostroboscopy closing vocal folds incomplete, funciona crack of oval form, the amplitude of vibrations of the vocal folds is reduced, the oscillations are symmetric, regular, mucous wave is present. When viewed through 1 year no recurrence of the disease, the voice is not changed, the data laryngoscopy and laryngostroboscopy are OK.

Conclusion histological research is of chronic laryngitis with ulceration, focal inflammatory growths epithelium with dysplasia of 1 degree.

Example 3.

Patient I., 49, and/b 31336 was treated in the ENT Department of the Mariinsky hospital 05.07.2010 on 13.07.2010 with a diagnosis of Chronic hyperplastic laryngitis. Keratosis vocal folds. Enrolled in a planned manner with complaints of hoarseness, fatigue voices.

Underwent surgical treatment is a direct reference microlaryngoscopy, deepithelization left and right vocal folds, PDT under endotracheal anesthesia. Dose entered sensitizer (photoditazine) amounted to 1.5 mg per 1 kg of body weight, the dose of light energy 300 j on the irradiated field (exposure time 10 minutes, the radiation power of 1 watt). Irradiation of the lower section of the larynx was performed using a removable reflector.

During the first days after surgery, the patient noted a moderate pain in the throat, keeping osobnosti. When subjective evaluation sonorous voice system GRBAS significant dynamics during the first day were noted. According to a computer acoustic voice analysis revealed an increase jitter, shimmer, reducing the ratio of signal to noise ratio compared to the preoperative period. If individualincome was determined moderate edema and hyperemia operated vocal fold, the mind is provided for swelling of the mucous membrane in the area haralabidou cartilage, if videolaryngoscopy - asymmetry and irregular fluctuations due to a significant reduction in the amplitude and frequency of oscillations operated vocal fold. Breath free. In the postoperative period is recommended adherence to a voice mode, a course vnutripartiynyh infusions, 2 weeks theopedia.

The gradual improvement of speech according to subjective and objective evaluation noted with a fifth day amid reduce swelling of the mucous membrane of the larynx and improve stroboscopic picture.

When viewed through 3 months voice returned to normal, the mucosa of the larynx pink, vocal fold gray, smooth, with laryngostroboscopy the amplitude of oscillations of the vocal folds is reduced, the oscillations are symmetric, regular, mucous wave is present. When viewed through 1 year no recurrence of the disease, the voice is not changed, the data laryngoscopy and laryngostroboscopy are OK.

Conclusion histological studies of chronic laryngitis with focal hyperkeratosis.

In all the examples, the treatment consisted of only one session of PDT, with the implementation of the invention provided a high treatment efficiency, as evidenced by the absence of relapses and multiple reduction of the treatment time compared with the method of the prototype.

With whom persons the treatment of benign tumors of the larynx, including surgical treatment followed by the application of photodynamic therapy, including introduction into a patient of a photosensitizer followed by laser irradiation zone neoplasms, characterized in that perform the intubation of the patient's endotracheal tube with an inflatable cuff at the distal end, in the lower part of the larynx between the vocal folds and the inflatable cuff on an endotracheal tube is placed under an angle of 50 to 80° in the direction of the trachea removable reflector facing the reflecting surface towards the lower surface of the vocal folds, which at the same time providing additional exposure to the lower part of the larynx, including the lower surface of the vocal folds, the reflected laser radiation, the duration of the session photodynamic therapy is on average, 600 C at a radiation power of 1.5 watts.



 

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14 cl, 1 dwg

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to maxillofacial surgery and otolaryngology. Method consists in exposure of caudal edge of nasal septum, separation of mucoperichondrial flap, excision of mucoperichondrial flap on concave side of cartilage, exposure of premaxilla region, excision of cartilage from perpendicular plate of ethmoid bone, ablation of cartilage strip along upper edge of septum, introduction of caudal edge of septum into cut between medial pedicles of alar cartilages and its fixation by sutures. Complete mobilisation of nasal pyramid is performed by its two-sided paramedical, lateral and transverse osteotomy. After that, skin is punctured with needles from lateral sides of dorsum of nose clivi, and ends of atraumatic suture material threads are passed into nasal cavity through slots of bone pyramid base osteotomy. Upper and lower edges of mobilised quadrangular cartilage are sewn with said threads. After bringing threads outside, nasal septum is reduced by their many-sided tightening and stabilised by fixation to plaster splint.

EFFECT: application of claimed invention makes it possible to ensure reliable intra-operation fixation of reduced cartilage of nasal cavity, recover nose aerodynamics, prevent deformity recurrence, eliminate cosmetic defect, provide possibility of realising active control over state of nasal septum in the nearest post-operative period.

3 dwg, 1 ex

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