RU2194545C2 - Method for treating subfold hemangioma in first life year children - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing direct micro laringoscopy. The subfold hemangioma is removed using surgical COCO₂ laser of 3- 5 W power and 0.1-0.2 s exposure time. Translaryngeal nasotracheal intubation is set for 3-5 days. Prednisolone is daily administered at a dose of 4-6 mg/kg. Extubation being done, Prednisolone is administered each second day at a dose of 5-6 mg/kg during 28-32 days. EFFECT: enhanced effectiveness of treatment; avoided tracheotomy and repeated surgical interventions under anesthesia.

Description

 The invention relates to medicine, namely to otorhinolaryngology.

 A known method for the treatment of sub-hemangioma using its cryodestruction under anesthesia [Chireshkin D.G. Chronic obstruction of the larynx of the pharynx, larynx and trachea in children. - M .: Rapid-Print, 1994. - 144 p.]. The disadvantages of the method are the need for preventive tracheotomy in connection with edema of the hemangioma and possible subsequent asphyxia of the child. Long tracheal cannula carriage causes pathological changes on the part of other organs and systems of the body, such as the cardiovascular, respiratory, central nervous system. The age of decanulation of such patients is from 11 to 25 months. In addition, repeated cryodestruction sessions are required, which necessitates repeated anesthesia.

 Corticosteroid therapy is used to treat hemangiomas of various critical localization, including sub-folding, [Holinger L.D., Lusk R.P., Green C.G. Pediatric laryngology and bronchoesophagology. Philadelphia - NY: Lippincott-Raven, 1997. - 402 p.]. To eliminate sub-hemangioma, the authors recommend the use of prednisone at a dose of 2-4 mg / kg / day for 4-6 weeks, followed by prolonged slow withdrawal of corticosteroids. However, there are numerous reports of the complete absence of the effect of using this method or a temporary reduction in the size of the tumor, followed by restoration of its volume after cessation of corticosteroid therapy [Soumekh B., Adams G.L., Shapiro R.S. Treatment of head and neck hemangiomas with recombinant interferon alpha 2b. // Ann Otol Rhinol Laryngol. - 1996. - Vol. 105, 3. - P. 201 - 206.]. In addition, long courses of daily hormone therapy in a child in the first weeks and months of life can lead to complications such as lag in height and weight from the age norm, decreased immunity, spontaneous fractures, glucosuria, ulceration of the skin, cushingoid syndrome.

There is also a method for eliminating sub-hemangioma using a surgical CO ₂ laser under anesthesia [Wenig BL, Abramson AL Congenital Subglottic Hemangiomas: A treatment update. // Laryngoscope. - 1988. - Vol. 98, 2. - P. 190-192]. To eliminate hemangiomas, the authors recommend using a laser power of 30 W, an exposure of 0.1 s. However, this method does not provide 100% cure. A coarse scab arising after the use of a high-power laser requires intubation of the child, and with unsuccessful attempts at extubation, a subsequent tracheotomy. Given that hemangioma may have continued growth, repeated laser operations are required, which can lead to the development of cicatricial stenosis of the larynx [Cotton RT, Tewfik TL Laryngealstenosis following carbon dioxide laser in subglottic hemangioma. // Ann Otol Rhinol Laryngol. - 1985. - Vol. 94, 5. - P. 494-497]. In addition, this method is contraindicated in children with massive hemangioma of the skin due to the possible germination in the larynx and the occurrence of intraoperative bleeding.

 The objective of the invention is a method for the treatment of sub-hemangioma, which reduces the risk of tracheotomy.

The problem is solved by a method consisting in vaporization with a surgical CO ₂ laser with a power of 3-5 W and a pulse time of 0.1-0.2 s followed by the appointment of prednisolone.

 The method is as follows.

Under fluorotan nasopharyngeal anesthesia, direct microlaryngoscopy is performed. The sub-folding hemangioma protruding into the lumen of the respiratory tract is removed with a beam of a CO ₂ laser with a power of 3 to 5 W, pulses of 0.1-0.2 s. The operation is bloodless. In connection with the scab formed as a result of laser irradiation and possible postoperative edema of the sub-follicular part of the larynx, an overgut nasotracheal intubation is performed; use an endotracheal tube whose inner diameter is 0.5 mm less than what is required by age. Starting from the first day after surgery, the child is injected with prednisone at the rate of 4-6 mg per kg of body weight per day (2/3 of the dose at 6 hours + 1/3 at 9 hours) for the first 3-5 days. The first attempt at extubation is performed no earlier than 3-5 days after the laser operation. On the next day after extubation, prednisone begins to be administered every other day at the rate of 5-6 mg of the drug per kg of body weight per day for 28-32 days (14-16 doses of prednisolone) with subsequent abrupt cancellation. There may be episodes of breathing difficulties, which may be associated with the re-growth of sub-hemangioma against the background of a respiratory viral infection, cosmetic cryosurgical interventions on the skin. In this case, depending on the severity of respiratory disorders, the treatment regimen is repeated in full (with respiratory stenosis of the II-III degree) or limited to the course of prednisolone according to the same scheme.

 Clinical example.

 Patient B., 4 months. 3 weeks (source. bol. 13979) was admitted to the hospital 09/10/98 with complaints of noisy breathing with the retraction of compliant places of the chest.

 From the anamnesis it is known that from birth there are hemangiomas on the skin of the face and chin, which grow slowly. At the age of 2 months. was hospitalized in a specialized "croupous" department of the hospital at the place of residence with a diagnosis of acute stenosing laryngotracheobronchitis, stenosis of the larynx, II-III art. Conservative treatment was carried out, including 7 days of percutaneous nasotracheal intubation. Corticosteroids (prednisone) were administered at a dose of 2 mg / kg body weight for 10 days, followed by gradual withdrawal. After discharge from the hospital, the breath remained noisy, due to increased respiratory disorders after 7 days, she was again hospitalized in the same hospital. During the last hospitalization, she was twice intubated for 6 and 4 days. Transferred to our clinic in connection with a suspected pathology of the larynx.

 Upon admission - a serious condition, breathing with the retraction of all compliant places of the chest. On the skin of the face - hemangiomas with a diameter of up to 4-5 cm. On the internal organs - without features. Neurologically - perinatal encephalopathy of a hypoxic type, hypertensive hydrocephalic syndrome. Weight - 5 kg 200 g.

 According to emergency indications, direct microlaryngoscopy was performed under fluorotan nasopharyngeal anesthesia. Under the left vocal fold, a rounded, soft-elastic consistency of a deep pink color was found, narrowing the lumen of the larynx by more than 2/3 - sub-hemangioma.

The tumor was eliminated by a beam of a CO ₂ laser with a power of 4 W; exposure time was 0.1 s each. The operation was bloodless. Percutaneous nasotracheal intubation was performed with a Portex tube with an internal diameter of 3.5 mm. Prescribed prednisone at a dose of 30 mg / day. Extubated on day 3 from the first attempt. After extubation, the prednisolone administration schedule was changed: administration of the drug every other day at a dose of 25 mg / kg (15 mg at 6 h and 10 mg at 9 h). Respiration gradually improved to free (by 4 days after extubation). Prednisolone is canceled on the 28th day after extubation (14 doses of the drug). Discharged 35 days after extubation in satisfactory condition with free breathing, voice is loud.

 After 2 months after discharge against the background of acute respiratory viral infections, there was a decrease in respiration to the phenomena of stenosis of the first degree. This episode of respiratory stenosis was stopped conservatively, using oral administration of prednisone every other day at a dose of 20 mg / day. within 14 days (7 doses of the drug). Despite repeated SARS in the first year of life, episodes of breathing difficulties were no longer noted. When examining the larynx under anesthesia 1 year after surgery, there is no data on the recurrence of sub-hemangioma. Hemangiomas of the skin - in the regression stage.

 The proposed method was used to treat 9 children with sub-hemangioma aged 2 to 5 months. No patient needed a tracheotomy. For complete relief of respiratory stenosis, 1-3 courses of treatment were required. Thus, the proposed method for the treatment of sub-hemangioma in children of the first year of life is highly effective, functionally intact, avoids tracheotomy and the adverse effects of repeated operations under anesthesia and improves the quality of life of the child.

Claims (1)

A method for the treatment of sub-hemangioma in children of the first year of life, including vaporization with a surgical CO ₂ laser, characterized in that vaporization is carried out at a power of 3-5 W and an exposure of 0.1-0.2 s, followed by tracheal intubation for 3-5 days and the introduction of prednisolone at a dose of 4-6 mg / kg of body weight daily for the time of intubation, followed by transfer after extubation to the introduction of prednisolone every other day at a dose of 5-6 mg / kg of body weight for 28-32 days.