RU2520253C1 - Method of treating nasopharyngeal tumours - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: under local anaesthesia with 10% lidocaine sprayed and applied on the mucous membrane of nasal passages, nasopharynx, and oral cavity, tubes 25-30 cm long made of an elastic body-indifferent material are inserted into both nasal passages. A square capron mesh exceeding an area of soft palate by 2-3 mm is anchored to the tubes. Tube ends escaping from the oral cavity are pulled up, and the soft palate with a uvula is lifted up front. Both tube ends are clamped in the angles of the mouth with lifting and fixing the soft palate with the uvula, enlarging an oropharyngeal lumen. That is followed by two 15-second tumour cryodestruction procedures every 3 minutes.

EFFECT: method enables providing more effective cryodestruction ensured by enlarging the oropharyngeal lumen, improving visibility of the tumour and adjoining intact tissues that enables targeted and selective exposure on the tumour.

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Description

The invention relates to medicine, namely to oncology, and can be used in the treatment of both benign and malignant tumors of the nasopharynx, when surgical treatment cannot be carried out radically, and the possibilities of chemo- and radiation therapy have been exhausted.

It is known that only benign tumors of small sizes are subject to surgical treatment, and in case of common ones, without germination in critical organs (brain and spinal cord, great vessels), it is removed by an extrafascial approach through the maxillary sinus, while for malignant tumors, operations are not used, but used mainly radiation and chemotherapy (Paches L.I. Tumors of the head and neck. M., Medicine, 2000, p. 322-327).

A known method of treating locally advanced cancer of the nasopharynx with chemotherapy (Kornetskaya L.L., Bolotina L.V. Drug treatment of locally advanced cancer of the nasopharynx. Russian Cancer Journal, No. 3, 2011, p. 43-46). The essence of this method is the use of various chemotherapy regimens. However, this technique is ineffective with chemoresistance of the tumor and the exhaustion of the possibilities of chemotherapy, which leads to the appearance of relapses and lympho-hematogenous metastases.

There is a method of cryotherapy for malignant tumors of various departments of the maxillofacial region: posterolateral parts of the tongue, extending to the bottom of the oral cavity and lateral walls of the oropharynx, selected as a prototype (Vasiliev A.V. Cryodestruction of tumors of the maxillofacial localization and ways to increase its effectiveness. Abstract Candidate of Medical Sciences, Leningrad, 1979). To increase the effectiveness of cryotherapy in the treatment of malignant tumors of the maxillofacial localization, in particular the oropharynx, it is proposed to carry out cryotherapy in conditions of impaired blood flow to the organ, achieved by ligation of the external carotid artery and / or its branches.

The decrease in blood flow in the tumor allows cryotherapy to radically remove some forms of malignant tumors. However, this technique simultaneously reduces the effectiveness of cryodestruction, which is manifested in the suppression of the processes of regeneration and repair of healthy tissues during the restoration of a defect caused by the violation of their vascularization (Rubinsky B. Cryosurgery. Medical cryology. Issue 1. Nizhny Novgorod. 2001. P.30-41; Budrik V .V. Physical foundations of cryomethods in medicine. Textbook. M., 2007, p.17-22).

In this regard, there is a need for the search and development of new approaches to the treatment of this category of patients.

The aim of this invention is to increase the effectiveness of treatment of patients with recurrent, resectable, chemoresistant nasopharyngeal tumors.

This goal is achieved by the fact that in the method of treating nasopharyngeal tumors, including cryodestruction, according to the invention, under local anesthesia with 10% lidocaine solution by spraying and lubricating the mucous membrane of the nasal passages, nasopharynx and oral cavity, 25-30 cm long tubes of elastic are inserted into both nasal passages material indifferent to the body, to which a square nylon mesh is hemmed, exceeding the area of the soft palate by 2-3 mm. Tubes are passed through the nasal passages, the ends of the tubes exiting the oral cavity are pulled forward and upward by raising the soft palate with the tongue, the ends of both tubes are fixed with clamps at the corners of the mouth, raising and fixing the soft palate with the tongue, expanding the lumen of the oropharynx for cryodestruction of the tumor in for 15 seconds, twice with a break of 3 minutes.

In the drawings (figures) presents a diagram of the proposed method for the treatment of tumors of the nasopharynx.

Figure 1 shows a general view of a nylon mesh with elastic tubes: 1 - nylon mesh, 2 - tubes of elastic material (droppers), which are elastic for the body.

Fig. 2 shows the layout of the nylon mesh during cryotherapy on the tumor: 1 - nasopharyngeal tumor, 2 - nylon mesh, 3 - tubes made of elastic material (droppers), which are elastic for the body, 4 - tongue.

Fig. 3 shows the fixation of the tubes with clamps at the corners of the mouth: 1 - clamps, 2 - tubes of elastic material indifferent to the body (droppers).

A square is cut out of the nylon mesh, which exceeds the area of the soft palate by 2-3 mm (Fig. 1-1). Two tubes 25-30 cm long are formed from elastic material indifferent to the body (for example, droppers) (Fig. 1-2, Fig. 2-3). Try on the tubes to the front area, mark the levels of the upper incisors on the tubes. At the level of marks, a square cut out of a nylon mesh is sewn (Fig. 1-1, Fig. 2-2). Tubes are passed through the nasal passages, the ends of the tubes exiting the oral cavity are pulled up and up and up the soft palate with a tongue (Fig. 2-4). The ends of both tubes are fixed with clamps at the corners of the mouth, they lift and fix the soft palate with the tongue, expanding the lumen of the oropharynx (Fig. 3).

A method of treating nasopharyngeal tumors is as follows.

A square is cut from the nylon mesh, which is 2-3 mm larger than the area of the soft palate. Two tubes 25-30 cm long are formed from an elastic material that is indifferent to the body (for example, droppers). Tubes are tried on to the front area, the levels of the upper incisors are noted on the tubes. At the level of marks, a square is cut from a nylon mesh. Then, the patient under local anesthesia with 10% lidocaine solution by spraying and lubricating the mucous membrane of the nasal passages, nasopharynx and oral cavity, insert the prepared tubes into both nasal passages, to which at the level of the upper incisors a square nylon mesh is sewn up, exceeding the area of the soft palate by 2-3 mm . Tubes are passed through the nasal passages, the ends of the tubes exiting the oral cavity are pulled up and up and up the soft palate with a tongue. The ends of both tubes are fixed with clamps at the corners of the mouth, they lift and fix the soft palate with the tongue, expanding the lumen of the oropharynx. After that, using a standard cryo-nebulizer, introduced through the mouth, carry out cryodestruction of the tumor with liquid nitrogen for 15 seconds, twice with a break of 3 minutes.

An example of a specific application of the method can serve as an extract from the medical history.

Patient K., born in 1941, medical history No. s-19132 / A was admitted to the head and neck tumors department of the RNII on September 23, 2011 with a diagnosis of nasopharyngeal cancer (T3N0M0), stage III. Condition after a full course of radiation therapy (65 Gy) and two courses of chemotherapy.

Morphological study - estesioneuroblastoma (No. 18834/11). Complaints on admission to headache, lack of nasal breathing and smell, a sharp decrease in hearing. During endoscopic examination and according to computed tomography (CT) data from 09/08/2011 - “... a multinodal nasopharyngeal tumor 4.7 × 3.6 cm, obstructing both choanas, infiltrating the mouth of the auditory tubes, spreading to the posterior nasal passages”.

09.28.2011 a patient in the operating room lying on his back, under local anesthesia with 10% lidocaine solution by spraying and lubricating the mucous membrane of the nasal passages, nasopharynx and oral cavity, 25-30 cm long tubes of elastic material indifferent to the body were inserted into both nasal passages, with which, at the level of the upper incisors, a square nylon mesh is hemmed, exceeding the area of the soft palate by 2-3 mm. Then the tubes were passed through the nasal passages, the ends of the tubes exiting the oral cavity were pulled up and the soft palate with tongue was pulled forward and upward. The ends of both tubes were fixed with clamps at the corners of the mouth, raised and fixed a soft palate with a tongue, expanding the lumen of the oropharynx. After that, the cryo-nebulizer probe was introduced through the mouth and brought to the nasopharyngeal tumor, then cryo-nebulization was applied to the tumor with liquid nitrogen for 15 seconds, twice with a break of 3 minutes. The patient suffered a satisfactory procedure.

The examination of the patient the next day revealed swelling of the mucous membrane of the tumor. On examination, after 4 days, swelling of the mucous membrane of the tumor was significantly reduced, areas of necrosis appeared.

10/05/2011, repeated cryodestruction of the nasopharynx tumor by the proposed method. 10/07/2011, the patient's condition is quite satisfactory, was discharged for outpatient monitoring.

During the follow-up examination 10/26/2011, the patient has no complaints. Nasal breathing is free, the sense of smell and hearing have recovered, and the headache has disappeared. An endoscopic examination revealed a thickening of the scar-modified mucosa at the site of the previous location of the tumor.

Subsequent examinations on 11/28/2011, 12/07/2011 and 10/08/2012 did not reveal data for continued tumor growth.

By the developed method, 2 patients with nasopharyngeal cancer were treated in stage III of the process.

The invention "A method for the treatment of nasopharyngeal tumors" is new, since it is unknown in the field of medicine in the treatment of nasopharyngeal tumors by cryodestruction.

The novelty of the invention is to increase the efficiency of cryodestruction by expanding the lumen of the oropharynx, which improves the visibility of the tumor and border healthy tissues, which allows you to selectively act on the tumor, improving treatment results.

The invention "A method for the treatment of nasopharyngeal tumors" is industrially applicable, as it can be used in healthcare in medical institutions of oncological profile, in oncology clinics.

Technical and economic efficiency lies in the fact that when carrying out the proposed method for the treatment of tumors of the nasopharynx, it becomes possible to accurately and efficiently carry out cryodestruction with the destruction of the tumor and restoration of nasal breathing, smell, hearing, and elimination of headache.

Claims (1)

A method of treating nasopharyngeal tumors, including cryodestruction, characterized in that under local anesthesia with a 10% solution of lidocaine by spraying and lubricating the mucous membrane of the nasal passages, nasopharynx and oral cavity, 25-30 cm long tubes of elastic material indifferent to the body are inserted into both nasal passages to which a square nylon mesh is sewn up, exceeding the area of the soft palate by 2-3 mm, the tubes are passed through the nasal passages, the ends of the tubes exiting the oral cavity are pulled up and up and up the soft palate with a tongue , the ends of both tubes are fixed with clamps at the corners of the mouth, lifting and fixing the soft palate with the tongue, expanding the lumen of the oropharynx, carry out cryodestruction of the tumor for 15 s, twice with a break of 3 minutes.

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