RU2593353C1 - Method for surgical treatment of pathological local defects of conjunctiva - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to medical ophthalmological equipment. For destruction of new local defects of conjunctiva its interested section is separated from the sclera, maximally pulled from an eye and subjected to cryocooling by cryoprobe of permeable porous titanium nickelide. Cryonecrosis of the defect tissue and their resorption is completed during 2-2.5 months.

EFFECT: method increases efficiency of treatment, simplifies and facilitates surgeon's operation.

1 cl, 2 dwg, 2 ex

Description

The invention relates to a medical surgical technique for ophthalmology.

Focal neoplasms of the tissues of the eyelids and conjunctiva are common eye diseases. Conjunctival neoplasms include cysts, dermoid formations, epithelial tumors, nevi, melanoblastomas. [Kovarevsky E.I. Eye diseases. -M .: Medicine, 1985. 279 pp.] In accordance with their diversity, various methods of surgical treatment are used. Such methods as laser excision, submersible diathermocoagulation, conjunctival radiation therapy are not used because of the risk of damage to the tissues of the eyeball. And in the presence of focal pathological formations of the eyelids, these methods can be used - each with its own advantages and disadvantages in relation to the type of disease. The most universal is the traditional method of instrumental surgery, familiar, affordable, cheap and relatively effective in terms of speed of rehabilitation.

Basically, the method includes dissecting the sclera conjunctiva at the height of the defect (tumor) parallel to its arch and separating the neoplasm in a blunt way. At the same time, there is a risk of damage to the orbital fiber, therefore, increased caution and microsurgical correctness of the manipulations are required. In the process of intervention, there is a need for careful diathermocoagulation and hemostasis of the tumor bed. The tumor is excised with the capture of a ring of surrounding healthy tissue. Nodal sutures, fixing the edges of the formed wound, are often tightened due to the complexity of the dosage of the manual suture. There are cases of inaccurate comparisons of the edges of the surgical wound, causing deformation of the eyeball tissue, which lead to cosmetic and functional defects [Krasnov ML, Belyaev B.C. Guide to eye surgery. -M .: Medizdat, 1988. 632 p.].

A known method of surgical treatment of neoplasms of the conjunctiva, including excision of the apical part of the defect with subsequent cryodestruction of its base. Cryodestruction of the defect residues allows to reduce the total invasion of the intervention, reduce the intraoperative damage to the healthy tissues surrounding the defect, simplify and improve hemostasis.

The method does not find wide clinical application due to the imperfection of the cryotechnics used. Known cryoapplicators are bulky and inconvenient in the microsurgical technique of eye operations.

Technical shortcomings of the cryoapplicator lead to its freezing to the wet surface of the wound and additional trauma to the tissues, uncontrolled freezing of deeper and more sensitive to the cold tissues of the eyeball (choroid of the retina), their inflammatory reaction [Shilyaev V.G. Cryotherapy and cryosurgery in ophthalmology // Military Medical Journal. 1976. No. 11, S. 68-70].

By the greatest similarity of the technical nature of this analogue is selected as a prototype.

The technical result of the proposed solution to the problem is to increase the viability of the operation, reducing the surgeon’s labor costs.

The specified technical result is achieved by the fact that in the method of surgical treatment of newly formed focal defects of the conjunctiva, including destruction of neoplasm tissue with the involvement of local cryotherapy, the destruction of the focal defect is carried out entirely by cryotherapy on the part of the conjunctiva separated from the sclera in the projection of the focal defect by the application of a nano-nickelapristol cryoprist exposure sufficient for cryonecrosis of the entire defect volume.

The efficiency of the method, its novelty and attainability of the technical result are due to the use of a cryoapplicator of permeable-porous titanium nickelide. A product of this material, made in any functional form (for example, a cylinder with a conical working end face of Fig. 1, a) and with dimensions adequate to the volume of the forthcoming impact, serves as a low temperature depot. A good correspondence to this role is the high heat capacity of the material, the relatively low heat transfer rate, and the porous structure that is easily filled with refrigerant when it is immersed. Chilled to cryotemperature (usually to a temperature of liquid nitrogen of -196 ° C) and brought into contact with body tissue, such a cryoapplicator causes rapid, and therefore locally controlled, deep frostbite, leading through a series of intermediate conditions to necrosis, i.e. destruction of frozen tissue.

The advantages of such a cryoapplicator, and therefore the cryodestruction method itself, include the accompanying anesthesia process, the exclusion of penetration of cancer cells from the operated tissue volume. Thus, the safety trauma inherent in classical excision is reduced, the risk of metastasis is reduced. The polished working surface of the cryoapplicator does not freeze to the tissue, providing free, non-invasive removal of the instrument.

The indicated features of the cryoapplicator prescribed the specifics of surgical procedures. The affected area of the conjunctiva is pulled (separated) with tweezers from the surface of the sclera and a cryoapplicator prepared for action in the form of tweezers captures and freezes the focal defect. The actions of separation and cryo-cooling are simplified and accelerated if the cryoapplicator is made in the form of nickel-titanium plates on the working surfaces of the branches of the tweezers (Fig. 1, b).

The exposure of cryoapplication is determined by the visual control of the surgeon and his subjective experience. To the required rate of cryodestruction, depending on the volume of tissue to be cooled and the cold capacity of the cryoapplicator, it can be repeated. In practice, this active stage of the operation is 20-60 s, which reduces the total duration of the operation and the nervous tension of the surgeon and the patient. The final steps of the operation are the periodic installation of disinfectant and reconstitution liquid preparations in the conjunctival sac and the control of convalescence.

Thus, the technical result of the proposed method in a generalized form seems to increase the viability of the treatment of these diseases and reduce the labor costs of the surgeon.

The set of features of the method in their causal connection with the technical result is original and not obvious for the conditional specialist of this technique, which indicates the compliance of the proposed solution with the criterion of "inventive step".

The drawings show:

FIG. 1 - design of cryoapplicators based on permeable-porous titanium nickelide used in ophthalmology:

a) a cryoapplicator with a cylindrical cryodepo;

b) cryoapplicator-tweezers with cryobranches (1 - cryodepo).

FIG. 2 - cryopexy of the nevus of the focal neoplasm of the conjunctiva of the eye (fragment of the operation).

After thorough experimental testing of the operation of the cryoinstrument and the surgical procedure, the proposed method was used in surgical interventions performed at the Regional Clinical Hospital IVOV (Krasnodar).

Example 1

Patient K., 27 years old. The diagnosis of the disease is the pigmented nevus of the conjunctiva of the left eye, located 2-3 mm from the limbus, at the position of "7-9 hours." The defect is oval, jelly-like, slightly swollen, with dimensions 3 × 4 mm, with blurry contours and interspersed pigment. Single dilated vessels are suitable for education. The eye is calm, the environment is transparent, the fundus is normal. Visual acuity 1.0.

The patient underwent surgery - local cryothermia of the nevus of the conjunctiva according to the method of the proposed method with the following specifics.

After epibulbar anesthesia by double instillation of a 0.5% alkain solution and application of an eyelid expander, the central part of the conjunctival nevus was pulled from the sclera of the eyeball with surgical tweezers. Cryopincers chilled in liquid nitrogen (Fig. 1, b) exfoliated and maximally drawn nevus tissue, immediately after cooling, was subjected to deep cooling by the action of nickel-titanium plates 1 of the jaws of cryopinz (Fig. 2). The exposure session lasted 25-30 seconds until the cryoapplicator was heated (thawed). According to the subjective idea of the depth of cryotherapy, the procedure is repeated twice. The operation was completed by instillation in the conjunctival sac of 20% sodium sulfacyl solution and postoperative observation. The reaction of the frozen tissue manifested itself as a small edema of the neoplasm with an increase in volume during the week with the installation of 1-2 drops of albucide 3 times a day.

After a month of outpatient observation in the nevus zone, single spotted pigment inclusions with normalization of the vascular pattern were noted. No relapse of the conjunctival nevus was observed within 6 months. The eye is calm, the environment is transparent, the fundus is normal, visual acuity is 1.0.

Example 2

Patient N., 47 years old. The diagnosis of the disease is a recurring hemangioma of the conjunctiva of the right eye after surgical treatment several months ago. The eye is calm, the environment is transparent, the fundus is normal. Visual acuity - 0.7 s + 0.5 D = 1.0.

A cavernous hemangioma with a diameter of 6 mm is soldered to the scars of the conjunctiva, located 5 mm from the limbus at the 4-5 hours position.

The surgical operation to remove hemangiomas is performed according to the method of the proposed method with the complication of actions relative to example 1.

To separate the scar-changed conjunctiva after the previous operation, an oval incision was made in it in a semicircle around the hemangioma. The selected portion of the conjunctiva is separated, maximally pulled from the eyeball by the cooled cryo-tweezers (Fig. 2) and held in this position for 45-50 seconds until the cryo-resource is used up. The cryopexy procedure was repeated twice, and a continuous suture was applied to the conjunctival incision using a surgical thread of titanium nickelide with a diameter of 45 μm.

The perifocal reaction to cryotherapy was manifested by a small edema with an increase in hemangioma volume. Outpatient treatment was carried out according to the above scheme. Fixed complete resorption of hemangiomas after 2.5 months. Within 6 months, the disease did not recur. Visual acuity remained 0.7 s + 0.5 D = 1.0.

According to the personnel involved in the operations, their results confirm the attainability of the claimed technical result of the proposed method. The readiness of the method for widespread use meets the criteria of the invention "industrial applicability.

Claims (1)

A method for the surgical treatment of newly formed focal defects of the conjunctiva, including the destruction of tissues of the focal defect using local cryotherapy, characterized in that the destruction of the focal defect is carried out entirely by cryotherapy on a defective conjunctival site separated from the sclera by applying a cryoapplicator of permezone-porous nitrocissiconium-pronezemicone-sensitive defect volume.

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