RU2353327C1 - Therapy for vascular middle ear tumours - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology. Tumour is exposed to pulse "КТП" laser light of wavelength 0.53 mcm, frequency 1-2 Hz, pulse energy 0.1-3 J with sequential pulse trains each including 1-5, during 1-2 sec at the distance 10 mm from a light guide end to the tumour thereafter gradually reduced 1 mm till complete tumour coagulation.

EFFECT: low-traumatic exposure ensured by gradual tumour coagulation accompanied with depressed angiostaxis.

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Description

The invention relates to medicine, namely to otorhinolaryngology.

A known method of destruction of vascular tumors using low temperatures by freezing the tumor, which leads to the formation of necrosis with subsequent scarring (V.G. Pogosov, V.F. Antoniev "Guide to otolaryngology". M: "Medicine", 1994, Ch. 6, pp. 537-545).

The disadvantage of this method is that the anatomical features of the middle ear require extremely delicate surgical intervention, leading to damage to nearby structures with the subsequent development of hearing loss and labyrinthopathy.

There is also known a method of laser destruction of vascular tumors using radiation from a neodymium laser. However, a neodymium laser with a wavelength of 1.06 μm is not suitable for surgery in the tympanic cavity, because it has a deep penetrating effect, which is dangerous during operations on the middle ear and can cause damage to the inner ear, followed by deafness, vestibular disorders, damage to the facial nerve.

A known method of treating vascular tumors of the middle ear, including laser exposure to the tumor (RF patent No. 2131221, class A61N 5/06, 1999). This method is carried out using a holmium laser. A Holmium laser with a wavelength of 2.09 μm causes the destruction of the tumor with the formation of a scab, with its repeated removal and repeated exposure to the tumor to the promotional wall of the tympanic cavity, resulting in increased bleeding.

The authors set the task - to create a less traumatic, non-invasive method that allows to stop bleeding when the tumor is detached from surrounding tissues, as well as to cause coagulation of the tumor vessels with subsequent replacement with connective tissue (scar), which will significantly reduce the number of postoperative complications and the patient's rehabilitation time.

The problem is solved in that in a method for the treatment of vascular tumors of the middle ear, including laser exposure to the tumor, it is proposed to carry out a pulsed exposure to radiation from a KTP laser with a wavelength of 0.53 μm, a frequency of 1-2 Hz, an pulse energy of 0.1- 3 J, while acting in successive series of pulses of 1-5 in each, for 1-2 seconds, starting from a distance of 10 mm from the end of the fiber to the tumor, gradually reducing it to 1 mm. until the tumor coagulates completely.

The method is as follows. After surgical treatment of the middle ear cavity, the working end face, a quartz-polymer laser waveguide with a diameter of 600 microns, is brought to the tumor and exposed to pulses of laser radiation with a wavelength of 0.53 microns, in series of 1-5 pulses in each. The first series of pulses with a frequency of 1-2 Hz is produced from a distance of 10 mm for 1-2 seconds until the entire surface of the tumor is exposed to laser radiation and acquires the color of “boiled meat”. Then the laser action is repeated in the same mode, gradually reducing the distance between the fiber and the tumor to 1 mm, which allows increasing the coagulation depth without increasing the area of the laser exposure. The resulting area of the coagulated tissue is removed using tools, and the exposed surface of the tumor is again subjected to laser exposure until the tumor is completely eliminated.

In cases where the tumor is small, i.e. does not go beyond the limits of the tympanic cavity, instrumental intervention is not carried out, limited to exposure to only a laser according to the same scheme.

The advantage of this method of removing vascular tumors of the middle ear cavity over the known ones is that laser radiation with a wavelength of 0.53 μm is selectively absorbed by the blood, therefore, passing through the mucous membrane and blood vessel walls, it has a more sparing effect, causing only coagulation. The coagulating effect of the laser contributes to the gradual coagulation of the tumor, accompanied by reduced bleeding, which prevents many complications.

Examples.

Patient B., 65 years old, was hospitalized in the ENT department on January 9, 2007 with a diagnosis of vascular tumor (chemodectoma) of the right ear. Complaint of hearing loss in the right ear, noise in the ear of a constant pulsating nature, headache. Sick for 2 years after the flu. When otoscopy of the right ear: the auditory meatus is free, wide, the eardrum is red in the lower parts, it bulges out. On the audiogram, a bone-air integral of up to 45 dB in the right ear. 01/10/07, under local anesthesia, tympanotomy of the right ear was performed. The tumor was located in the area of the pro-bacterial wall of the tympanic cavity, had a pink color, and when it was touched, it bleed. Using radiation from a KTP laser with a wavelength of 0.53 μm, an energy of 3 J, the tumor was coagulated by exposure to 5 series of pulses of 3-5 in each.

In this case, the effect was carried out using a fiber, the end of which was originally installed at a distance of 10 mm from the tumor and gradually brought it closer to a distance of 1 mm

The bleeding of the tissue is insignificant, there is no blood loss. In the postoperative period, there was no noise in the ear; hearing improved. Observation for 6 months - no tumor recurrence.

Patient S., 70 years old, was hospitalized in the ENT department on September 5, 2007 with a diagnosis of a vascular tumor (chemodectoma) of the right ear. Complaint about hearing loss in the right ear, pulsating noise in the ear of a constant nature, periodic spotting from the ear. According to the patient, hearing loss over 10 years, a pulsating noise in the ear for 5 years, spotting during the last month. With otoscopy of the right ear: the ear canal is obstructed by the formation of a pink color on a wide base, when touched easily bleeding. On the X-ray of the temporal bones according to Schuller and Mayer, this formation occupies the entire tympanic cavity and the auditory meatus. On the audiogram is a mixed form of hearing loss of the third degree.

09/20/07, under general anesthesia using a KTP laser, coagulation and instrumental removal of the tumor from the outer and middle ear were performed. Tissue bleeding is moderate. Blood loss 200 ml. At the follow-up examination of the patient in October: there is a slight noise in the ear, tumor growth in the tympanic cavity was not detected.

Using this method will provide a less traumatic effect on the patient due to the gradual coagulation of the tumor, accompanied by reduced bleeding, which will prevent many complications.

Claims (1)

A method for the treatment of vascular tumors of the middle ear, including laser exposure to the tumor, characterized in that they carry out a pulsed exposure to radiation from a KTP laser with a wavelength of 0.53 μm, a frequency of 1-2 Hz, an energy of 0.1-3 J per pulse, while act in successive series of pulses of 1-5 in each, for 1-2 s, starting from a distance of 10 mm from the end of the fiber to the tumor, gradually reducing it to 1 mm until the tumor coagulates completely.