RU2364369C1 - Laser bilateral tonsillectomy technique - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology. Mucous membrane is incised at the distance 1-2 mm from edge of anterior palatine arch from both sides with a distal part of a light guide end of a semiconductor laser by continuous contact method at lasing output power 8.5 W. Then through a raspatory incision, upper pole of palatine tonsil is separated and dislocated from tonsillar niche, thereafter commissures and adhesions are dissected between palatine tonsil and tonsillar niche to its lower bottom pole, then it is cut off from pharynx side with the a distal part of the light guide end by continuous contact method at lasing output power 9.5 W.

EFFECT: method provides radical removal of palatine tonsil with minimal surgical injury with using high-energy lasing of the diode laser.

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Description

The method relates to medicine, namely to otorhinolaryngology.

Known methods for removing palatine tonsils using a cutting tool [1, 2].

Removal of the tonsils is carried out under local infiltration anesthesia with a 1% solution of novocaine. A mucosal incision is made with a scalpel along the edge of the anterior palatine arch from the upper pole to the edge of the tongue. Then the palatine tonsil is pulled forward and the mucosa is dissected from the upper pole of the tonsil to the posterior arch. Dissection of the mucosa is done with the tip of an acute scalpel with a light superficial incision. The next step is husking the tonsils. The surgeon takes the forceps with the captured tonsil in the left hand, in the right - the raspator, with the help of which it separates the tonsil from the anterior arch. Under the control of vision with a scalpel or scissors cross the amygdala-connecting connective tissue jumpers. When husking, a capsule of the tonsil appears, walking along which from front to back and from top to bottom, the tonsil stands out from its bed. Isolation of the tonsil should be made as low as possible, after which a loop is applied to the tonsil and, gradually compressing it, the tonsil is cut off.

The disadvantages of the analogue are:

1. Bleeding can occur both during and several hours after surgery. Bleeding is extremely dangerous, since the area of the palatine tonsils is rich in vessels, in the location of which anomalies are often observed.

2. Late postoperative bleeding may be due to the discharge of a scab or thrombus from a vessel located in the tonsil niche.

3. The formation of deforming scars of the anterior and posterior palatine arches of the soft palate.

As a prototype taken the method of ablation of the tonsils [3, 4], performed

CO ₂ - a laser with a wavelength of 10.4 microns, a radiation power of 15-18 W, a spot diameter of 2 mm. Ablation was carried out in 4-6-fold repetitions (10-15 s each). Initially, tonsil tissue was removed in the middle of the distance between the anterior and posterior arches to a depth of 0.3-0.5 cm. Next, tissue was radially removed over the entire surface of the tonsils to the same depth, leveling the surface. Large gaps crater-like expanded, edges smoothed to prevent the accumulation of caseous masses in these places. For better access to the upper pole, the anterior palatine arch was pushed away with a spatula. Existing scars were dissected with a laser beam, smoothing the edges of the gaps of the existing additional lobules.

The disadvantages of the prototype are:

1. This method does not lead to a radical removal of the palatine tonsil.

2. Preserved palatine tonsil remnants do not exclude relapse of tonsillitis, paratonsillar abscesses and further autoimmune progression of tonsillar disease.

3. The proposed method in most patients leads to severe scarring of the remnants of the tonsil and its cystic change.

The aim of this invention is the radical removal of the tonsils with minimal surgical trauma using high-energy laser radiation from a diode laser.

This goal is solved by the fact that after local infiltration anesthesia with 1% lidocaine solution or under endotracheal anesthesia, a mucosal incision is performed, 1-2 mm from the edge of the anterior palatine arch, with the distal part of the end of the fiber of the MILON-LAHTA semiconductor laser contacted in continuous mode with an output power of laser radiation of 8.5 watts. Then, through the incision, the upper pole of the tonsil is separated with a raspator and dislocated from the tonsil niche. Laser radiation transmitted through the distal end of the optical fiber in a continuous contact mode with a laser radiation power of 9.5 W performs a gradual dissection of adhesions and adhesions between the palatine tonsil and tonsil niche to its lower pole, followed by its cutting from the side wall of the pharynx. The operation is performed in the operating room.

Concrete example

Under observation were 12 patients aged 19 to 51 years with a decompensated form of chronic tonsillitis, who had previously undergone conservative therapy that did not contribute to the reduction of recurring tonsillitis.

Example. Patient F., 28 years old, was hospitalized in the ENT department of AOKB with a diagnosis of Chronic tonsillitis, decompensated form. Relapses of tonsillitis. A patient has a history of angina 3-4 times a year with a temperature reaction of up to 39.5 ° C, accompanied by pain in large joints and heart. Previously, the patient had repeatedly undergone conservative treatment, which included washing the lacunae of the tonsils with 0.2% furatsillin solution up to 10 times 2 times a year, physiotherapy and vitamin therapy. Against the background of the treatment, no clinical improvement was observed. The loosening of the surface of the tonsils, their hypertrophy, purulent plugs in the gaps of the tonsils remained, relapses of tonsillitis were observed (Fig. 1). Given the lack of effect from the treatment, the patient was recommended surgery - bilateral laser tonsillectomy.

Under endotracheal anesthesia, an incision of the mucous membrane is performed, stepping 1-2 mm from the front edge of the anterior palatine arch, on both sides of the distal end of the fiber end of the MILON-LAHTA semiconductor laser in a continuous manner with an output power of 8.5 W of laser radiation ( figure 2). Then, through the incision with a raspator, the upper pole of the palatine tonsil is separated and dislocated from the tonsil niche (Fig. 3). Laser radiation transmitted through the distal end of the optical fiber in a continuous contact mode with a laser radiation power of 9.5 W performs a gradual dissection of adhesions and adhesions between the palatine tonsil and tonsil niche to its lower pole, followed by its cutting from the side wall of the pharynx (Fig. 4 )

In the postoperative period, the patient received general and local anti-inflammatory therapy, non-narcotic analgesics were prescribed for 2 days. On the 7-10th day after the operation, the tonsil niche was cleansed of plaque fibrin, the remains of the palatine tonsil tissue were not determined in the niche (Fig. 5).

At the same time, a biochemical assessment of the state of lipid peroxidation and antioxidant protection in patients before and after surgery was performed (Tables 1, 2).

The dynamics of lipid peroxidation and antioxidant protection before and after surgery (table 1, 2).

Table 1. Indicators in nmol / l Indicators before surgery in nmol / l (n = 12) After the operation, nmol / L (n = 12) Lipid hydroperoxides (normal - 25.0-35.0 nmol / ml) 38.4 ± 0.6 31.4 ± 0.6 Diene conjugates (normal - 25.0-40.0 nmol / ml) 53.7 ± 0.8 43.2 ± 0.7 Malondialdehyde (normal - 5.0-6.5 nmol / ml) 7.5 ± 0.7 5.8 ± 0.3

Table 2. Indicators in mcg / ml Indicators before surgery in μg / ml (n = 12) After surgery in μg / ml (n = 12) Tocopherol acetate 22.7 ± 0.5 25.1 ± 0.7 (norm - 20.0-25.0 mcg / ml) Ceruloplasmin (normal - 20.0-25.0 mcg / ml) 16.1 ± 0.6 20.2 ± 0.7

Information sources

1. Ermolaev V.G., Preobrazhensky B.S., Rutenburg D.M., Temkin Y.S. Surgical diseases of the pharynx, larynx, trachea, bronchus and esophagus. - M .: Medgiz. - 1954. - S.108-116.

2. Elantsev B.V. Operative otorhinolaryngology. - Alma-Ata. - 1959. - 485 p.

3. Zbyshko Ya. B. A comparative analysis of tonsillectomy and ablation of the tonsils with a carbon dioxide laser // Bulletin of Otorhinolaryngology. - 2007. - No. 4. - S.15-17.

4. Zbyshko Ya. B. The effectiveness of using a carbon dioxide laser in the treatment of patients with chronic tonsillitis // Bulletin of otorhinolaryngology. - 2007. - No. 5. - P.57-59.

Claims (1)

A method of laser bilateral tonsillectomy of a decompensated form of chronic tonsillitis by means of contact laser excision of the palatine tonsil, characterized in that the mucous membrane is cut 1-2 mm apart from the edge of the anterior palatine arch on both sides of the distal part of the end of the fiber of the semiconductor laser by the contact method in continuous mode with output power 8.5 W of laser radiation, then through the incision with a raspator, the upper pole of the palatine tonsil is separated and dislocated from the tonsil niche, after which dissects the adhesions and adhesions between the palatine tonsil and amygdala niche to its lower pole and cut it off from the lateral pharyngeal wall with the distal part of the fiber end in the contact way in a continuous mode with a laser radiation power of 9.5 watts.

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