RU2251991C1 - Method for treating patients for nodal forms of thyroid gland diseases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out instrumentally controlled intervention with high intensity laser radiation being supplied to thyroid gland node via light guide brought into thyroid gland node body with a conductor through soft tissues. Dynamic temperature control is carried out 0.2-0.7 cm laterally far from nodal form boundary as the instrumental control in performing laser radiation treatment. 37-40°C being reached, laser radiation treatment is to be stopped. Laser light guide is introduced into the thyroid gland node 2-3 cm far from conductor end.

EFFECT: enhanced effectiveness of non-invasive, organ-saving treatment without narcosis being applied.

2 cl

Description

The invention relates to endocrinology and is intended to optimize the treatment of nodular, mainly benign, thyroid formations with high-intensity laser exposure using temperature control at the border of pathological and healthy tissue.

A known method for the surgical treatment of nodular forms of thyroid diseases, which consists in removing the pathological tissue site by the acute route, i.e. using a scalpel (see Surgical endocrinology. Kalinin AP, Maystrenko NA, Vetshev PS, “Peter” 2004, p.227-264).

The disadvantage of this method is the high morbidity, the likelihood of intra- and postoperative complications.

A known method for the treatment of nodular thyroid glands, combining the incision of soft tissues in the acute way and the isolation of pathological tissue using a CO ₂ laser (Martino A.A. et al. Use of a laser in thyroid surgery. M: Issues of endocrinology 1989, p. 177-180).

The applied treatment method is also traumatic and does not exclude the possibility of postoperative complications; it involves dissection of the soft tissues of the neck with the formation of a cosmetic defect and the use of anesthesia.

A known method of treatment of nodular thyroid glands, selected as a prototype, including intervention under instrumental control using high-intensity laser radiation in the thyroid gland using at least one fiber, punctured into the thickness of the node by a conductor through the soft tissue of the neck (RF Patent No. 2143933 )

The method involves an intervention using high-intensity laser radiation, carried out by the puncture method through the soft tissues of the neck into the thyroid gland under instrumental control. For the procedure, high-intensity diode or neodymium lasers with a power of 1 to 7 watts are used. The exposure time when using a diode laser ranges from 60 to 450 s and from 60 to 500 s for a neodymium laser. Intervention in the node is carried out under instrumental (ultrasound) control, which allows to eliminate errors as much as possible when introducing the fiber into the node and to introduce the laser radiation source directly into its thickness.

The disadvantage is that this method involves only an approximate calculation of the laser exposure time and its power.

It is known that the thermal effect of laser radiation in a tissue depends on the coefficient of absorption and deposition of energy by this tissue, which is determined by its optical and thermal properties, thermal conductivity, blood circulation rate, etc. To achieve the maximum effect of laser thermal radiation, taking into account all of the listed properties of tissues, it is necessary to identify parameters that can be objectively controlled.

Thus, the objective of the invention is the creation of an effective way to control laser hyperthermia, which would allow the most effective treatment in one session and minimize heat damage to healthy tissue.

This problem is achieved by the fact that in a method for the treatment of nodular forms of thyroid diseases, including intervention under instrumental control using high-intensity laser radiation with a power from 2 to 6 W into the thyroid gland using a fiber, punctured into the thickness of the node by a conductor through soft tissue, it is proposed as an instrumental control during laser irradiation, dynamically record the temperature lateral to the border of the nodular shape by 0.2-0.7 cm and when achieved and values of 37-40 ° C, stop the laser exposure.

In addition, it is proposed that the laser fiber be inserted into the thyroid gland 2-3 mm further than the end of the conductor.

An increase in temperature to 80 ° C in the pathological zone leads to coagulation and necrosis with subsequent scarring. When the tissues are heated to 37-40 degrees, irreversible changes do not occur. By controlling the temperature in a healthy zone, it is possible to choose the time of optimal exposure using a relatively low power of laser radiation (mainly 5-6 W).

The method is as follows.

After preliminary anesthesia of the skin, 2-3 ml of novocaine under instrumental control using an apparatus for ultrasound examination, a puncture needle G 19 is inserted into the thickness of the nodular formation, through which the optical fiber is delivered 2-3 mm further than its end.

To achieve the maximum effect from laser exposure, the end end of the fiber is cleaned from the polymer surface.

The needle during the session is not removed from the node, which allows to simplify the technique and provide a “dry” field. Before the procedure, the liquid contents of the node are evacuated as much as possible, which helps to increase the effectiveness of treatment.

Through the second puncture needle G 19, under the control of the apparatus for ultrasound examination, a temperature sensor is installed 2-7 mm lateral to the border of the nodular formation. High-intensity laser radiation from the inside on the node tissue is carried out. A diode laser with a wavelength of 810 nm in the field of infrared light is used, which operates in a constant mode and has a power at the end of the optical fiber of 5-6 W. Irreversible tissue destruction occurs when locally heated to 80 degrees, which can be achieved in nodes of different volume and density, manipulating the time of laser exposure. With local heating of the site, especially with continuous irradiation, part of the heat with the bloodstream is transferred to the surrounding tissue. Heating to 37-40 degrees does not imply irreversible structural changes, so the laser radiation session continues until the specified temperature is reached in the controlled zone. Monitoring the temperature gradient of the pathological and healthy zone allows you to achieve the optimal heating effect in the node without damaging the intact zone.

The method is illustrated by examples.

Example 1

Patient M., b. 1961 Diagnosis: Nodular cystic-modified goiter 111 tbsp., Established on the basis of ultrasound, scan of the thyroid gland, fine-needle puncture biopsy. When the node was punctured, about 5.0 ml of brown cystic fluid was obtained according to the cytological conclusion - nodular goiter with cystic degeneration. After local anesthesia of 2 ml of novocaine over the zone of the alleged interference under the imaging control of the ultrasound apparatus into the thickness of the nodular formation, a fiber was drawn through the G19 needle. The end of the fiber is located 2-3 mm further than the end of the needle, which allows it to be protected from overheating and can well control the location of the fiber, which during the session as a bright glowing spot is visible on the monitor screen of the ultrasound machine. A temperature sensor was introduced through the second needle G19 and installed under ultrasound control 0.5 cm lateral to the border of the nodular formation. A laser exposure session was performed with a Lotus-810-15 diode laser having a wavelength of 810 nm in the infrared region, operating continuously with a power of 6 W at the fiber end. The session lasted 5 minutes until the temperature sensor reached 37 degrees. In this case, subjective sensations are minimal. Within 7 days, there was pain in the area of laser exposure without a temperature reaction. After a month, a tendency toward a decrease in the volume of the node was outlined; after six months, a hypoechoic area without clear boundaries was visualized during ultrasound testing at the site of nodular formation, which as a percentage amounted to 1/10 of the original volume. Upon physical examination of the patient after 10 months, the thyroid gland had a somewhat heterogeneous structure without nodular formations.

Example 2

Patient 3., born in 1987 D-3: Follicular adenoma. The diagnosis is confirmed by clinical and instrumental and cytological data. After preliminary anesthesia of the skin under ultrasound control, a fiber guide 2-3 mm further than the end of the needle was inserted into the node through the G19 needle, and a thermal sensor was installed 5 mm lateral to the node boundary through the needle. A laser exposure session was performed with the Lotus-810-15 instrument in a continuous mode with a power of 6 W for 6 minutes until the temperature sensor readings of 37 degrees were reached. Subjective sensations are not noted. The trend towards a decrease in the node was outlined in 2-3 weeks. A distinct effect of laser treatment was noted six months later: with physical control, the patient’s thyroid gland does not contain nodules, with ultrasound control there is a hypoechoic zone without clear boundaries, which is 1/10 of the original volume.

Example 3

Patient K., b. 1965 DZ: Nodular euthyroid goiter 111 tbsp. with cystic degeneration. The diagnosis is based on clinical, instrumental and cytological data. With a fine needle puncture biopsy, 10 ml of brown cystic fluid was obtained according to the cytological conclusion - cystic goiter. After local anesthesia, 2 ml of novocaine under ultrasound control through a G19 needle after preliminary evacuation of the cystic contents, a disposable quartz fiber was inserted 2-3 mm further than the end of the needle. Through the second needle, a thermal sensor is installed 5 mm lateral to the node boundary. A laser exposure session was performed with the Lotus-810-15 instrument in a continuous mode with a power of 6 watts. wavelength of 810 nm for 5 min 30 sec. Until the temperature sensor reaches 37 degrees. Subjective sensations were absent. Within 7-8 days, slight pain was noted in the area of exposure. A tendency to decrease in volume was outlined in 1 month. A distinct decrease in the node was determined by the end of 4 months, but there was an accumulation of cystic contents in the volume of about 1.5 ml in the nodular formation, in the cytogram there were multinuclear large cells, fibrocytes, and signs of productive inflammation. The patient had a second laser irradiation session using the same technique, but lasting 3 minutes. A noticeable effect of the treatment was noted after 3 months: during physical examination, the thyroid gland does not contain nodes; during ultrasound examination, a zone of reduced echogenicity without clear boundaries is visible, which is 1/10 of the original volume.

Using this technique (a 6 W Lotus power 810-15 laser laser at the end of an optical fiber operating in continuous mode with a wavelength of 810 nm in the infrared range), 26 patients with benign and oncological thyroid nodules were treated . The exposure time was determined by controlling the temperature gradient at the border of pathological and healthy tissue. In all observations, within six months after laser hyperthermia, a process of scar formation is observed, the size of which did not exceed 10% of the initial volume of pathological tissue.

The proposed method is less traumatic, because carried out by the puncture method, organ-saving and does not imply the trauma of healthy tissue, aesthetic, because does not leave any consequences from the intervention; does not imply stress on the psycho-emotional status of the patient; profitable from an economic position, because carried out on an outpatient basis, without the use of anesthesia, with a minimum treatment time. Thus, ethical, psychosomatic and socio-economic problems are simultaneously solved.

Claims (2)

1. A method for the treatment of nodular forms of thyroid disease, including intervention under instrumental control using high-intensity laser radiation in the thyroid gland node with a fiber guide punctured into the thickness of the node by a conductor through soft tissue, characterized in that a dynamic control is performed during laser exposure registration of temperature lateral to the border of the nodular form is 0.2-0.7 cm, and when the value reaches 37-40 ° C, the laser action is stopped. 2. The method according to claim 1, characterized in that the laser fiber is inserted into the thyroid gland 2-3 mm further than the end of the conductor.