RU2463024C1 - Method of electrochemical lysis of intraocular neoplasms - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be applied in ophthalmology and ophthalmic oncology for electrochemical destruction of intraocular neoplasms Electrochemical lysis is performed in four successive stages, each 5 minute long, with current intensity 30 mA, with application of three platinum electrodes, one electrode is flat superficial, made in form of circle from platinum net 11,0 mm in diameter, with two round holes 2.5 mm in diameter, located in diametrically opposite way, is applied on sclera, the other two electrodes, needle intratumour, are introduced into tumour perpendicular to sclera through holes in wall; at the first stage two needle electrodes are used: one as anode, another as cathode; at the second stage polarity of needle electrodes is changed; at the third stage superficial electrode is used as anode and two needle electrodes - as cathodes; at the fourth stage superficial electrode is used as cathode and two needle electrodes are used as anodes.

EFFECT: invention ensures formation of necrosis zone in entire volume of tumour

Description

The invention relates to medicine and can be used in ophthalmology and ophthalmic oncology for electrochemical destruction of intraocular neoplasms.

At the present stage of development of ophthalmic oncology, preference is given to organ-preserving methods of treatment of intraocular neoplasms.

In this regard, the method of electrochemical lysis (ECL) (destruction) is of interest. The principle of ECL is based on the direct effect of direct current on the tumor: electrodes (anode, cathode) are injected directly into the tumor - with the occurrence of aseptic necrosis and delayed chemical exposure to the tumor by electrolysis products. Alkali and hydrogen are formed at the cathode, hydrochloric acid, oxygen, and chlorine are formed at the anode. The greatest damage is formed in the area of the cathode. The ECL process is not accompanied by an increase in temperature, which fundamentally distinguishes this method from radiofrequency, plasma and laser ablation.

Electrochemical lysis is quite successfully used to treat breast cancer, with malignant neoplasms of the liver and liver metastases from various primary tumors, with benign prostatic hyperplasia, with cancer of the esophagus, lung, pancreas, and skin.

A known method of ECL of intraocular neoplasms (patent for the invention No. 2336059). In this method, needle electrodes are used, while electrochemical destruction occurs around the electrodes and between them, and not in the entire tumor volume.

The objective of the invention is to develop an effective method for electrochemical lysis of intraocular neoplasms.

The technical result is the formation of a zone of necrosis in the entire tumor volume.

The technical result is achieved due to the fact that the electrochemical lysis is carried out in four consecutive steps lasting 5 minutes each with a current of 30 mA using three platinum electrodes, with one electrode being flat surface made in the form of a circle of a platinum grid with a diameter of 11.0 mm with two round holes 2.5 mm in diameter, located diametrically opposite, impose on the sclera, and two other electrodes, needle intratumoral, are introduced into the tumor perpendicular to the sclera through holes in the mesh ; at the first stage, two needle electrodes are used: one as an anode, the other as a cathode; at the second stage, the polarity of the needle electrodes is changed, at the third stage, a surface electrode is used as an anode, and two needle electrodes are used as cathodes, at the fourth stage, a surface electrode is used as a cathode, and two needle electrodes are used as anodes.

The method is as follows.

To conduct ECL, 3 electrodes are used: one flat surface and two needle intratumoral.

The circular surface electrode with a diameter of 11.0 mm with two round holes with a diameter of 2.5 mm located at a distance of 5.0 mm from each other is made in the form of a grid of platinum wire with a diameter of 0.05-0.1 mm with a mesh size of light 0.1-0.8 mm. At any point on the grid, a flexible electrical wire is rigidly attached, the free end of which is designed to be connected to an ECL apparatus.

Each intratumoral needle electrode is made of 0.3 mm thick platinum wire, has a L-shaped shape, the length of the active vertical part is selected individually depending on the tumor prominence according to ultrasound data, the length of the horizontal part is 1.5-2.5 mm. A flexible electrical wire is rigidly attached to the free end of the horizontal part of the cathode, the free end of which is designed to be connected to the ECL apparatus using a terminal. The electric wire, the horizontal part and the next 2 mm of the vertical part of the electrode are coated with a bioinert electrical insulating material, for example fluoroplast-4.

At the preparatory stage for ECL, if necessary, rectus muscles are cut off to provide access. Transsclerally diaphanoscopically clarify the location and size of the tumor, determine the boundaries of the projection of the base of the tumor on the sclera and outline them with a coloring matter, for example, 1% aqueous-alcoholic solution of brilliant green.

A surface electrode is applied to the sclera within the previously designated boundaries of the base of the tumor.

Intratumoral electrodes are transsclerally inserted into the tumor structure, through round holes in the surface electrode, perpendicular to the sclera, not reaching the tumor apex of 1.0 mm.

To introduce an intratumoral electrode, a spear with screw length adjustment and a cannula for instruments of 27 G are used. The required spear length (the length of the extrascleral part of the cannula is 27 G + sclera thickness (according to preliminary ultrasound examination) + the depth at which the electrode is inserted into the tumor (according to preliminary ultrasound examination)). Then, using a spear installed in the cannula canal, a sclerotomy is performed by introducing a full-length spear into the tumor structure. The spear is removed from the cannula canal and an electrode is introduced into it (into the canal) of a pre-selected length (defined as the length of the spear).

After placing the electrodes, ECL of intraocular neoplasm is carried out in four consecutive stages lasting 5 minutes each with a current of 30 mA. At the first stage, two needle electrodes are used: one as an anode, the other as a cathode. At the second stage, the polarity of the needle electrodes is changed. In the third step, a surface electrode is used as the anode, and two needle electrodes are used as cathodes. In a fourth step, a surface electrode is used as a cathode, and two needle electrodes are used as anodes. Changing the polarity of the electrodes is performed by switching them on the device for ECL.

Upon completion of ECL, the surface electrode is removed, intratumoral electrodes and 27 G cannulas are removed. Sclerotomy is not sutured. When the muscles are cut off, they are hemmed into place.

The invention is illustrated by the following data.

ECL according to the proposed method was performed on 4 eyes with large tumors: prominence - more than 8 mm, base width - from 14 to 17 mm (experiment) - before enucleation.

Used surface electrodes in the form of a grid of platinum wire with a diameter of from 0.05 to 0.1 mm with a cell size in the light from 0.1 to 0.8 mm. A surface electrode was placed on the sclera along the previously designated boundaries of the base of the tumor. Intratumoral electrodes were introduced deep into the tumor through round holes in the surface. ECL was carried out in four consecutive stages lasting 5 minutes each with a current strength of 30 mA. At the first stage, two needle electrodes were used: one as an anode and the other as a cathode. At the second stage, the polarity of the needle electrodes was changed. At the third stage, a surface electrode was used as an anode, and two needle electrodes were used as cathodes. At the fourth stage, a surface electrode was used as a cathode, and two needle electrodes were used as anodes. The polarity of the electrodes was changed by switching them on an ECL device.

An additional 4 eyes with similar large tumors before enucleation had an ECL session with the same parameters, but using needle electrodes (control). The electrodes were introduced deep into the tumor perpendicular to the sclera, parallel to each other, on the line of the largest diameter of the base, at a distance of 2.5-3.5 mm to both sides of the center of the base, without bringing the tumor to 1.0 mm.

Histological studies were performed with the determination of the area of the necrosis zone. Analysis of histological preparations was carried out using an Olympus VX51 microscope, a BP70 digital video camera, and ANALYSIS software (Germany) (microscope image analyzer).

As a result, it was found that in the experimental eyes the necrosis zone occupied the entire tumor volume, unlike the control ones, where the zones of intact tumor tissue were clearly defined.

Thus, the claimed invention provides for the formation of a zone of necrosis in the entire volume of the tumor.

Claims (1)

The method of electrochemical lysis of intraocular neoplasms, characterized in that the electrochemical lysis is carried out in four consecutive steps lasting 5 minutes each with a current of 30 mA, using three platinum electrodes, while one electrode is flat surface, made in the form of a circle of a platinum grid with a diameter of 11, 0 mm with two round holes with a diameter of 2.5 mm, located diametrically opposite, impose on the sclera, and two other electrodes, needle intratumoral, are inserted into the tumor perpendicular Jarno sclera through the openings in the grid; at the first stage, two needle electrodes are used: one as an anode, the other as a cathode; at the second stage, the polarity of the needle electrodes is changed, at the third stage, a surface electrode is used as an anode, and two needle electrodes are used as cathodes, at the fourth stage, a surface electrode is used as a cathode, and two needle electrodes are used as anodes.