RU2743328C1 - Method of laryngotracothelasty in patients with tracheostoma - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology. A diode laser with wavelength 980 nm is used in contact continuous mode at power 7 W or in pulse mode at power 30 W. Laser fiber under conditions of local anesthesia is delivered through tracheostoma channel and performing laryngotracheal plastic under control of rigid endoscope.EFFECT: method enables performing benign neoplasms removal, dissecting cicatrical constriction of larynx and first tracheal rings in local anesthesia conditions, retrograde inspection of the larynx is performed, the lower surface of the vocal folds is inspected, and the risk of breakage of the rigid laser fiber is excluded.1 cl, 2 ex

Description

The invention relates to medicine, namely to laryngotracheoplasty, and can be used to perform laryngotracheoplasty in patients with tracheostomy.

A known method of carrying out laryngotracheoplasty using direct supporting microlaryngoscopy, which is performed only under anesthesia with maximum relaxation of the patient's muscles (Babiyak VI, Govorun MI, Nakatis Ya.A. Otorhinolaryngology. Manual. In 2 volumes. Volume 2. - 2009). The laryngoscope is inserted into the lumen of the larynx, then it is fixed on the patient's chest with a special support or suspension device. It is necessary to combine the lumen of the laryngoscope and the lumen of the larynx in a plane convenient for bringing the microscope and the position of the surgeon, convenient for performing manipulations in the area of localization of the pathological process.

The disadvantages of this method are the need for general anesthesia, the inability to assess the active mobility of the vocal folds and cricoid joints during the operation, the possibility of injury to the patient's front teeth, since the laryngoscope is supported on them, in the need for an additional surgeon's skill to pass the laser fiber through the larynx.

A known method of laryngotracheoplasty of the larynx using fibrolaryngoscopy with local anesthesia (Mukhamedov M.R., Cheremisina O.V., Kulbakin D.E. Fibrolaryngoscopy at the stages of diagnosis and treatment of malignant neoplasms of the larynx // Siberian Journal of Oncology. - 2010. - Appendix 2 ). The working end of the fiberscope is passed along the bottom of the nasal cavity or, if necessary, through the mouth. Manipulations with surgical instruments, including laser fiber, are possible only through the working channel of the fiberscope. This method is the closest analogue.

The disadvantage of this method is the use of surgical instruments only through the working channel of the fiberscope, which limits the manipulation of instruments and creates a high risk of breakage of the rigid laser fiber during retrograde examination of the area of localization of the pathological process.

The technical result of the invention consists in the absence of a working channel limiting the movement of the surgical instrument, in the elimination of the risk of breakage of the rigid laser fiber, the possibility of retrograde examination of the larynx, in the simplicity and convenience of access, and the use of only local anesthesia.

The specified technical result is achieved in the method of laryngotracheoplasty in patients with tracheostomy by laser exposure, in which a diode laser with a wavelength of 980 nm is used in a continuous contact mode at a power of 7 W or in a pulsed mode at a power of 30 W, the laser fiber under conditions of local anesthesia is passed through tracheostomy canal and laryngotracheoplasty is performed under the control of a rigid endoscope.

The introduction of a laser fiber through the tracheostomy opening under the control of a rigid rhinoscope allows avoiding the risk of damage to the rigid laser fiber, assessing the entire volume of surgery, in contrast to the method using a microfiberscope.

The possibility of retrograde imaging of the subglossal larynx and the lower surface of the vocal folds ensures the safety of surgical procedures.

In the available information sources, there is no description of the performance of endoscopic surgical operations on the larynx and upper trachea through the tracheostomy, there is no information about the passage of the laser fiber through the tracheostomy. Unlike all known methods, laryngotracheotomy is performed without the use of general anesthesia.

The method is carried out as follows.

The patient is in the supine position; a roller can be placed under the patient's shoulders to extend the cervical spine. Next, the tracheostomy tube is removed, if necessary, the tracheostomy canal is sanitized with an aspirator. A rigid endoscope with an angle of view of 45 ° or 70 ° is installed in the opening of the tracheostomy, the trachea and the retrograde sub-vocal part of the larynx are examined. A local anesthetic (10% Lidocaine solution) is applied with a laryngeal lubricant, after which a laser fiber is inserted into the opening of the tracheostomy, and under the control of a rigid endoscope, a scar is dissected or a benign neoplasm (papilloma, granuloma) is removed.

The essence of the method is confirmed by the following clinical examples.

Example 1

Patient Sh., 36 years old, has been suffering from papillomatosis of the larynx since adolescence. At the age of 19, the first removal of the laryngeal papillomas was performed, after 2 years complaints of hoarseness resumed. Subsequently, repeated surgical interventions led to cicatricial deformity of the larynx and narrowing of the upper airways, which required the imposition of a tracheostomy. On admission, during an endoscopic examination of the larynx, massive papillomas were revealed along the medial edge of the vocal folds, the tracheostomy canal also with multiple papillomas. Surgical intervention under anesthesia was contraindicated due to the high risk of pneumothorax, and the location of the papillomas on the anterior surface of the trachea and the subglossal larynx made laser removal under the control of a fiberscope impossible, since bending the working end of the fiberscope would break the rigid laser fiber. It was decided to remove papillomas through a tracheostomy under local anesthesia. A rigid endoscope with an angle of view of 45 ° was placed in the tracheostomy canal, removal of papillomas and incision of the scar of the anterior surface of the subglossal larynx was performed with a diode laser with a wavelength of 980 nm, in a continuous contact mode at a power of 7 W. The postoperative period was uneventful.

Example 2

Patient N, 36 years old, after an accident was in the intensive care unit for a long time, on the seventh day of mechanical ventilation a tracheostomy was applied. Three months later, when attempting to decannulate, the patient noted complaints of difficulty breathing; when viewed with a rigid endoscope from an angle of view of 45 °, a cicatricial annular narrowing of the sub-vocal larynx was visualized. Under local anesthesia with a diode laser with a wavelength of 980 nm, in a contact pulsed mode at a power of 30 W, the scar was dissected, the airway lumen was restored, which made it possible to perform decannulation.

According to the claimed method, papillomas were removed and the scars of the subglottic larynx were dissected in a group of patients, including 25 people: 15 women and 10 men aged 18 to 67 years. 35 interventions were performed - in case of relapse in some patients, repeated dissection of cicatricial adhesions and removal of papillomas were performed. Rigid rhinoscopes with different angles of view were used depending on the localization of the surgical field and the anatomical features of the patient.

The method allows performing the removal of benign neoplasms, dissecting the cicatricial narrowing of the larynx and the first rings of the trachea under local anesthesia, which is important in case of frequent relapses of the disease. Retrograde examination of the larynx provides information about the inferior surface of the vocal folds.

Claims (1)

The method of laryngotracheoplasty in patients with tracheostomy by laser exposure, characterized in that a diode laser with a wavelength of 980 nm is used in a continuous contact mode at a power of 7 W or in a pulsed mode at a power of 30 W, the laser fiber under local anesthesia is passed through the tracheostomy channel and laryngotracheoplasty is performed under the control of a rigid endoscope.