RU2153373C1 - Method for carrying out faucial tonsils lacunotomy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying holmium laser radiation at a rate of 1 impulse per 1 mm of travel path, 5-10 Hz frequency, 5-10 W power, 1J constant impulse power. The procedure is repeated 3-4 times increasing power from 5 to 10 W in reducing stage-by-stage depth to which the light guide working end is introduced. EFFECT: lower risk of traumatic complications.

Description

 The invention relates to medicine, namely to otorhinolaryngology.

 A known method of carrying out lacunotomy of the tonsils with the help of galvanocauter. The method is used for compensated and subcompensated forms of chronic tonsillitis in order to create a free outflow of palatine tonsils separated from the gaps of the tonsils and consists in dissecting the tonsils of the tonsils with a galvanocauter, which significantly improves the course of the disease and reduces the frequency of exacerbations (see I.A. Lopotko, O.Yu. Lakotkina "Acute and chronic tonsillitis". State publishing house of medical literature, Leningrad, 1963).

 The specified method is quite traumatic, leads to the formation on the tonsils of a significant area and depth of burns, the quality and speed of healing of which leave much to be desired, and subsequent scars can negate the results of the intervention and lead to the formation of cysts on the tonsils.

 There is also known a method for dissecting tonsil lacunae using radiation from a YAG-neodymium laser (λ-1.06 μm) (See Ovchinnikov Yu.M., Bezchinskaya M.Ya., Novitsky VV, Mashtakov DM "Possibilities of use surgical laser in the treatment of chronic tonsillitis. "Herald of Otorhinolaryngology, 1996, N3, pp. 44-45). However, dissection of tonsil lacunae by the beam of this laser is performed using very high power (50-80 W), which also creates a large burn surface, reduces the quality of healing of the postoperative wound.

 The objective of the invention is a method of lacunotomy of the tonsils, with less trauma.

 This problem is solved by the method consisting in the fact that the working end of the holmium laser fiber is introduced into the gap to its entire depth, then removed from the gap, sending laser radiation pulses in a spiral with a step of 1 mm and increasing the diameter of the spiral from 0 to 5 mm at a speed 1 impulse per 1 mm at a frequency of 5-10 Hz, power 5-10 W and constant energy per pulse 1 J with 3-4-fold repetition of the procedure with an increase in power from 5 to 10 W with a decrease in the depth of introduction of the working end from stage to stage .

 In this case, firstly, the use of holmium laser radiation (λ-2.09 μm) in the destruction of tonsil tissue provides minimal perifocal inflammation. This effect is due to the fact that the radiation λ -2.09 μm, in contrast to the radiation λ -1.06 μm, has a very high coefficient of absorption by water. Therefore, moisture-saturated tissues of the tonsils are subjected to destruction by laser radiation of λ -2.09 μm at a very low power (5-10 W). The destruction mechanism is not based on a burn reaction, but on the ablation effect, in which the tissues adjacent to the laser wound do not experience thermal stress, which contributes to better wound healing. These fundamental differences in the mechanism of tissue destruction allow us to fundamentally solve the clinical problem, that is, by means of lacunotomy to eliminate the conditions for maintaining chronic inflammation in the tonsils.

 Secondly, when performing laser lacunotomy according to the proposed method, a funnel-shaped recess is formed from a convoluted slit-like lacuna. In this case, after epithelialization, the bulk of the tissues of the tonsils continues to perform all the functions inherent in the normal tonsil, since in the postoperative period the lymphoid tissues surrounding the laser wound not only do not experience thermal overheating, but under the influence of subthreshold (residual) laser radiation they survive the wound process faster.

 In practice, the method is as follows.

 Under local application anesthesia Sol. Lidocaini 10% laser fiber with a diameter of 400-600 μm is inserted as deep as possible into the lacuna and with an energy of 1 J pulse, pulse repetition rate of 5-10 Hz, spiral motion with a gradual slowdown in progress and an increase in the radius of the spiral from 0 to 5 mm, in increments spirals up to 1 mm are removed from the gap. This achieves the destruction of the tissues of the bottom of the gap and its walls. An average of 6-8 turns. The last 2-3 turns of slow movement of the working end of the fiber destroy the tonsil tissue around the mouth of the gap. A similar action is repeated 3-4 times, and each subsequent time the working end of the fiber is introduced to a smaller depth (1-2 mm) compared to the previous time, and the laser radiation power is changed from 5 to 10 W with each subsequent action (once). With proper manipulation, a funnel-shaped depression with a wide mouth is formed in place of the gap, the surface of which is covered with a whitish, dry scab. No bleeding is observed. When measuring the depth of lacunae 14 days after the operation using a probe, a decrease in their depth by 1/3 - 1/2 from the original was noted. The intervention was carried out once. As a rule, patients easily tolerated surgery and the postoperative period.

 Example 1

 Patient N., 38 years old, on an outpatient basis. He complained of frequent, more than 4 times a year, exacerbations of chronic tonsillitis. On examination: the tonsils are located behind the arches, the lacunae are widened, there is purulent-caseous discharge. Between the tissue of the tonsils and the arches multiple scars, the arches of the tonsils are hyperemic. After a course of conservative treatment in order to remove purulent-caseous discharge, 09/12/98 laser lacunotomy of the tonsils was performed using a holmium laser. At the first stage of lacunotomy, laser radiation with a power of 5 W was then repeated with a power of 7 W and 10 W. The patient underwent the operation well, in the early postoperative period there were complaints of transient sore throat. When examined after 7 days, there is no discharge in the gaps, the edges of the laser wounds are covered with fibrin, there are no signs of a spilled inflammatory reaction. In the follow-up, a single acute respiratory viral infection 3 months after lacunotomy, which did not go into exacerbation of chronic tonsillitis. On examination 13.01.99 - tonsils are clean, tonsil lacunae are wide, without detachable, tonsil arches are not hyperemic. Subjectively, the patient feels improved health, increased efficiency.

 Example 2

 Patient G., 14 years old. She complained of frequent SARS, exacerbations of chronic tonsillitis more than 3 times a year, decreased performance, fatigue, sweating. On examination: an increase in the anterior cervical lymph nodes up to 5 mm in diameter, the tonsil arches are hyperemic, the tonsils are soldered with the arches for a considerable length, overlap the pharyngeal lumen by 1/3 on each side. Tonsil lacunae are closed, purulent discharge is obtained during washing. 09/08/98 produced a lacunotomy of the tonsils with radiation of a holmium laser. Applied at the first stage of a 5 W lacunotomy, then the intervention was repeated with a power of 6, and 8, and 10 watts. The intervention was well tolerated, in the early postoperative period without features. At the control examination, January 20, 1999 there is no discharge in the gaps, the arches are not hyperemic, the tonsils are on a par with the arches. Notes a significant improvement in general condition. On the ECG, rhythm normalization, school performance improved. During the observation period, respiratory viral infections were not observed.

 When treating the proposed method with 14 patients (female 8, male 5, age 10 to 38 years), we observed pain and intoxication in only two patients, while when treating in a known manner using an Nd: YAC laser, these complaints are met in 100% of patients and hold for 2-4 days.

Claims (1)

 A method of laser lacunotomy of palatine tonsils, including the introduction of the working end of the fiber to the depth of the gap, characterized in that they use holmium laser radiation and the fiber is extracted by sending laser radiation pulses in a spiral with a step of 1 mm and an increase in the diameter of the spiral from 0 to 5 mm at a speed of 1 pulse / 1 mm of the path at a frequency of 5 - 10 Hz, power of 5 - 10 W, constant energy per pulse of 1 J, and 3 to 4-fold repetition of the procedure with an increase in power from 5 to 10 W with a decrease in the depth of introduction of the working end of the fiber from stage k stage.