Laser lacunotomy of the palatine tonsils. Painless removal of tonsils with laser lacunotomy. Technique for laser destruction of lymphatic tissue

Palatine tonsils (tonsils) are called clusters lymphoid tissue located in the oropharynx between the palatine arches. Their main task is to prevent infection from entering Airways person. They are part of the pharyngeal lymphoid ring, which belongs to immune defense first line. These are the only tonsils that are accessible for examination without the use of auxiliary instruments.

Structure and functions of the tonsils

The lymphoid tissue of the tonsils forms folds called lacunae (crypts). Textile palatine tonsils has a porous structure. When pathogenic microorganisms enter the lacunae of the tonsils, an inflammatory reaction begins, aimed at destroying foreign agents. As a result, pus accumulates in the gaps - exudate, consisting of dead microorganisms, leukocytes, and desquamated dead epithelium of the tonsils. This pus can be seen when examining the tonsils in the form of plugs in the lacunae. At the same time, the tonsils themselves increase in size, become reddened and loose. This pathological condition tonsil is called chronic tonsillitis and requires adequate treatment.

Most often the causative agent chronic tonsillitis is beta-hemolytic streptococcus. The danger of streptococcus for humans lies in its aggressive cardiotropic effect: a chronic focus of beta-hemolytic streptococcus is fraught with rheumatism and heart valve defects.

In some cases, chronic tonsillitis can be treated with medication, but if conservative treatment turns out to be ineffective, surgical intervention is necessary. Until recently, the most common operations in ENT practice on the tonsils were tonsillectomy (removal of the tonsils) and tonsillotomy (excision of the tonsils). IN Lately The modern organ-preserving method is gaining popularity surgical treatment palatine tonsils - lacunotomy, which is performed using a laser.

The essence of the operation

Lakunotomy allows you to save the tonsils and clears their lacunae from pathological contents. The operation is performed in outpatient setting, under local anesthesia. Most often, this manipulation is performed using a laser beam, which minimizes trauma to surrounding tissues. Laser lacunotomy is also called molecular resonance destruction of the palatine tonsils.

The essence of the operation is that under the influence of a high-frequency laser, coagulation of pathologically altered lacunae occurs along with their contents. After “evaporation,” crusts (scabs) form on the surface of the tonsils, which are soon torn off, leaving scar tissue in their place. Over time, the scars are epithelialized, and the functions of the lacunae are completely restored.

After surgery, a sufficient amount of lymphoid tissue remains in the tonsils for these small organs to carry out their functions. The likelihood of recurrence of chronic tonsillitis is significantly reduced, since the source of chronic infection is eliminated.

The cost of such an operation varies widely, depending on the volume of the operation and the clinic that performs it. For example, in Moscow, laser lacunotomy in state and municipal medical institutions costs 3-8 thousand rubles, and in private clinics - 11-28 thousand. A similar trend is emerging in other Russian cities (St. Petersburg, Rostov, Smolensk).

Advantages and disadvantages

Laser lacunotomy surgery has many advantages over other types of tonsil surgery:

• is organ-preserving;
• does not injure surrounding tissues;
• is bloodless;
• has high efficiency;
• requires local anesthesia;
• does not take much time;
• can be carried out on an outpatient basis;
• complications rarely occur;
• fast recovery.

Due to minimal trauma to the tissues of the tonsils surrounding the operated lacunae, laser lacunotomy does not contribute to swelling of the tonsils. As a result, the drainage of normal lacunae is not disrupted, which reduces the risk of infectious postoperative complications. In addition, the laser has a stimulating effect on lymphoid tissue, increasing its ability to regenerate, therefore, in comparison with classical surgical tonsillotomy, it is more preferable.

Like any other intervention in the body, laser lacunotomy has its drawbacks. Its main disadvantage is considered to be the lack of radicality of the operation. This deficiency is inevitable, since the lymphoid tissue in the tonsils remains, which in some cases is the cause of relapse of chronic tonsillitis. If after lacunotomy the disease recurs more than twice a year, this is the basis for repeated excision of the tonsils or their removal (tonsillectomy). In most cases, reviews from both patients and doctors about the results of the operation are positive.

In addition to insufficient radicality, the disadvantages of laser lacunotomy include bleeding from injured tissues. This complication is rare and is caused by a violation of the procedure technique or misbehavior patient during early recovery period.

Indications and contraindications

The main indication for laser lacunotomy is recurrent chronic tonsillitis. If exacerbation of chronic tonsillitis occurs more than twice a year, its conservative treatment is considered ineffective and surgery to excise the lacunae is recommended.

Indications for laser tonsillotomy are:

• hypertrophy of the tonsils (when they begin to interfere with swallowing and breathing);
• scar and adhesions on the surface of the tonsils (they prevent the outflow of contents from the lacunae);
• the appearance of rheumatic pain in the joints, heart (even in the absence organic lesions these bodies);
• acute rheumatism;
• peritonsillar abscess;
• frequent exacerbation of chronic kidney disease (pyelonephritis, glomerulonephritis);
• lack of effectiveness from conservative treatment.

When prescribing a lacunotomy, the doctor should not forget that the operation also has its contraindications. These include:

• acute tonsillitis or exacerbation of chronic tonsillitis;
• the patient has a high temperature;
• chronic diseases internal organs in the acute phase;
• decompensated heart and kidney diseases;
• heavy diabetes;
• pathologies of the blood coagulation system;
• malignant neoplasms.

In this case, the first three contraindications are considered relative and after normalization of the patient’s health condition, laser surgery it can be done on his tonsils. It is not recommended to perform lacunotomy on pregnant women and children under 10 years of age.

Preparation for the procedure

If the patient has any chronic diseases, they need to be treated. The operation can only be performed during remission chronic pathologies. Before lacunotomy, it is also necessary to treat all carious teeth, since carious cavities are a source of chronic infection: after surgery on the tonsils, they can cause infectious complications.

Operation technique

The operation is minimally invasive, so it is performed in a special manipulation room, and not in the operating room. Before the intervention, the patient’s tonsils are irrigated with a local anesthetic solution; if necessary, infiltration local anesthesia is administered into the tonsils themselves.

After the anesthesia takes effect, the doctor moves the laser manipulator to the surface of the tonsils without touching them. The beam dissects adhesions, scars and burns out pathologically altered tissues. During surgery, the patient smells burnt meat.

The total duration of the operation ranges from 10 to 20 minutes (depending on the size of the affected area of ​​the tonsils). No hospitalization is required after the intervention. The patient should not eat food for 4 hours after the procedure.

Rehabilitation period

In order for the wound surface of the tonsils to quickly clear the scab and epithelialize, the patient must behave correctly during the rehabilitation period.

The first day after the intervention, the patient will experience a sore throat. This is a completely natural situation, since at the site of laser action there remains a bare wound surface that is exposed to digestive enzymes. To reduce pain, the patient is prescribed non-steroidal anti-inflammatory drugs that have a strong analgesic effect: Nimesulide, Ketoprofen, Ketanov.

Due to the entry of coagulation products (after laser treatment of tissues) into the bloodstream, an increase in body temperature is possible in the first days after the procedure. Solve the problem of elevated temperature can be done using the same anti-inflammatory drugs that are prescribed for pain. Antipyretic drugs (Paracetamol, Ibuprofen) should be taken when the patient’s body temperature rises above 38°C. WITH low-grade fever you should not fight, as this is a protective natural reaction of the body to soft tissue injury.

Already from the first day, the wound surface of the tonsils begins to become covered with a fibrous coating, which gradually dries out and forms a crust (scab). Underneath the crust, the healing process takes place. You cannot remove this scab yourself: this is fraught with the formation of deep wounds on the tonsils. The scab goes away on its own in 6-7 days. To speed up the healing process of the wound surface, during the first week the throat must be treated with antibacterial and antiseptic solutions: irrigate with Bioparox, rinse with Miramistin, Chlorhexidine, solutions of furatsilin, Lugol, chamomile, sage. You can suck lozenges with antiseptics (Faryngosept, Septefril, Strepsils).

Food first postoperative days should be warm, but not hot, liquid or semi-liquid, and not contain hot spices. There should be a minimum amount of salt in dishes.

After a week, crusts begin to peel off the surface of the tonsils. According to patient reviews, many believe that they have experienced an exacerbation of chronic tonsillitis: the amount of discharge increases, and many plugs appear on the surface of the tonsils. However, this aggravation is false. In fact, the scab is rejected, the surface of the tonsils is exposed and the lacunae under the scab are cleared of purulent contents. The cleansing process lasts about a week.

2-3 weeks after laser lacunotomy, the tonsils become dense, clean, and shrink to normal sizes. Such changes indicate that the operation was successful.

Throughout the recovery period, patients should visit their doctor regularly to monitor the healing process.

Laser lacunotomy is a modern method of treating chronic tonsillitis. The operation is not radical, so it cannot completely prevent the occurrence of exacerbations. To clear all problematic lacunae, in case of severe tonsillitis, patients are recommended to undergo the procedure several times.

The issue of the advisability of performing laser lacunotomy should be decided by an otorhinolaryngologist, based on the results of an objective examination, laboratory and instrumental methods studies and effectiveness of previous conservative therapy.

Laser lacunotomy - modern way treatment of tonsillitis, which involves removing destroyed tonsils. Unlike traditional tonsillectomy, laser removal of tonsils is less traumatic and allows you to return to normal life within a few days. During the operation, tissues in which pathological changes are noted are cauterized. High-frequency light radiation, including carbon dioxide laser, allows the evaporation of diseased tissues. The high temperature of the laser destroys diseased cells, coagulation is observed when a dead layer is created, under which new cells that are not affected by the disease can develop. Due to this, a therapeutic effect is achieved without further disturbances in the immune system. However, cauterization is not always possible, so in some cases you have to part with the tonsils. Partial removal of tonsils is usually performed if their condition is not advanced.

Indications

The main indication for the procedure is chronic tonsillitis, which cannot be treated conservative methods. If exacerbations of the disease occur more than 3 times a year, surgery to cauterize the tonsils is indicated.

Also, laser treatment of tonsils is carried out in the absence of results of conservative treatment at the time of acute inflammation. If a sore throat does not subside after a course of antibacterial therapy using a drug to which bacteria are sensitive, laser cauterization of the tonsils is indicated.

The development of complications is another indication for laser treatment. In such a situation, it is necessary to urgently eliminate pathological process in the tonsils, which is why laser therapy is used. This the only way prevent further development of complications and direct treatment to eliminate problems, without additional use antibiotics.

Otolaryngologist Ivan Leskov tells whether to remove tonsils or not.

Contraindications

Laser lacunotomy of the palatine tonsils also has certain contraindications, the observance of which is necessary. It is strictly prohibited in the following cases:

• moment of exacerbation chronic sore throat with the development of rapid purulent process- first the acute process is removed, and only after that cauterization is carried out. Laser therapy at this point can only be used in exceptional cases;
• oncological diseases, regardless of the area of ​​localization of the tumor;
• pathologies of the pancreas, including diabetes mellitus;
• heart failure due to any reason;
• lung diseases, in which there is a significant decrease in the lumen of the bronchi;
• kidney pathologies;
• open tuberculosis;
• menstruation;
• skin diseases;
• untreated caries;
• insufficient blood clotting due to low platelet levels - despite the fact that the laser cauterizes the blood vessels, preventing profuse bleeding, there is always a risk of damage to the main vessel, which results in significant blood loss, which can pose a serious danger if blood clotting is insufficient;
• pregnancy;
• breastfeeding period;
• children's age from 1 year to 10 years. Children undergo such treatment in exceptional cases for emergency indications, when other therapy is impossible, and leaving the tonsils without treatment poses a threat to life.

If contraindications are identified, the otolaryngologist selects another therapy that is acceptable in a particular condition. This can be either various conservative treatment of tonsils or traditional surgery to excise the tonsils, as, for example, in the case of cancer.

Types, advantages and disadvantages

Today, 4 types of laser treatment for tonsils are used. The choice of method depends on the degree of damage to the throat and general condition sick.

1. Cauterization (laser destruction). The procedure uses a holmium laser. During cauterization, the scars are dissected and the foci of inflammation inside the tonsils are destroyed, as well as the lacunae are cleaned and expanded. Healthy tissues are not damaged, which minimizes the recovery period.
2. Ablation is used if the pathological process affects a large area of ​​the tonsils. Using laser and fiber optics, the top layer of tissue is removed. During the procedure, the lacunae expand significantly and the process of tissue renewal begins, and after it there is a particularly strong release of purulent plugs. Complete cleansing The tonsil is fixed after 2.5-3 months.
3. Tonsillotomy. This type of treatment is used when severe defeat parts of the tonsil. Using an infrared laser, only the diseased area is excised. The healthy portion of the tonsil remains functional. This partial removal often used in children's and adolescence to eliminate defects in the structure of the tonsils that cause chronic tonsillitis.
4. Tonsillectomy. The operation is performed if the tonsil is completely destroyed and restoration of its tissue is not possible. Lymphoid tissue is completely removed by laser. The edges of the wound are baked due to the high temperature emitted by the laser. Thanks to this, the risk of wound infection during the healing process is eliminated and the recovery period is reduced.

The advantages of laser treatment of tonsils are recognized by doctors as follows:

• local anesthesia - all manipulations are performed only under local anesthesia, in contrast to a standard operation, which requires general anesthesia;
• speed of the operation - it takes no more than 30 minutes;
• the rehabilitation period is no more than 4 days with complete removal of the tonsils;
• outpatient cauterization and partial removal;
• minimal or no bleeding;
• reducing the risk of complications to a minimum;
• prevention of damage to healthy tissue;
• absence pain after surgery after the local anesthesia wears off;
• complete antiseptic by cauterizing the wound.

The positive aspects of using laser in the treatment of tonsils have made lacunotomy with its use very common.

This method of treatment has practically no disadvantages. With it, if according to indications the tonsils need to be removed incompletely, the risk remains reappearance tonsillitis in a few years. Also a relative disadvantage is the high cost of the operation. It can only be carried out by a highly qualified specialist, which significantly increases the price.

Carrying out the operation

Performing surgery using a laser is a low-traumatic intervention, which is why in most cases it is performed on an outpatient basis.

Preparation

Complicated preparation before the operation is not required. After its appointment it is surrendered general analysis blood and biochemical. A throat swab may also be required with further microscopic examination and sowing on nutrient medium. Sanitation of the oral cavity is carried out.

In the evening before surgery, in case of sleep disturbance due to anxiety, a reception is indicated sedatives. Despite the fact that the laser cauterizes the wound, if necessary, if there is a slight deviation from the norm in blood clotting, the use of agents to increase clotting is indicated for two weeks before the procedure.

On the day of surgery, the last meal is possible 6 hours before the procedure, and you stop drinking water 4 hours before. It is recommended to stop smoking one day before removal of the tonsils. Brushing your teeth is mandatory. No other preparation is required.

Technique

The operation is performed with the patient in a sitting position. With complete excision of lymphoid tissue, anesthesia is carried out by injecting the surgical area with lidocaine. If cauterization is prescribed, the tonsils are lubricated with an anesthetic composition.

The manipulator, which generates the laser beam, is brought to the affected area, but it does not come into contact with it. If lesions are cauterized with pathological changes, optional equipment not required. With complete excision, the tonsil is grasped and held with special tweezers, then it is trimmed and completely removed. The smell of burnt meat that appears during manipulation is normal.

Postoperative period

When laser therapy on the tonsils has already been carried out, it is important to properly organize the rehabilitation period, as this will minimize the risk negative consequences and speed up the healing of damage.

• exposure to the cold;
• eating hard foods;
• visit to the bathhouse;
• vaporization;
• physical exercise;
• smoking;
• alcohol consumption;
• scream;
• eating hot and cold food.

• eating pureed foods at room temperature;
• rinsing with salted water adding 2 drops of iodine per glass;
• throat treatment with eucalyptus and propolis sprays;
• rinsing with decoctions medicinal plants such as calendula and chamomile.

Video review of a patient who underwent surgery to remove her tonsils.

Complications and their prevention

If all medical instructions are followed, complications do not arise after the operation. IN in rare cases Burns of healthy tissue and bleeding are possible several days after the intervention. To prevent negative consequences, all manipulations should be performed only by a qualified specialist, and during the recovery period the patient must strictly follow all recommendations.

Attending doctor

Laser lacunotomy is performed by an otolaryngologist who has completed a special training course and has the proper qualifications.

Laser treatment of tonsillitis is one of the most innovative and effective means combating the chronic inflammatory process in the tonsils, which is aimed at completely ridding the patient of pathogenic microflora in the tissues of the tonsils and at the same time allows doctors to keep this part of the throat intact. All these efforts of doctors are connected with the fact that the tonsils play important role in the formation of a strong immune system patient, act as an organic filter that blocks further advancement of infectious microorganisms and pathogenic viruses into the respiratory tract. Laser treatment tonsillitis has its advantages, as well as contraindications for use. Let's take a closer look at the pros and cons of laser cauterization of inflamed tonsils.

Laser lacunotomy is a molecular resonance destruction of the palatine tonsils, on the surface of the mucous membrane and in the deeper tissues of which acute or chronic disease develops inflammatory process caused by an infectious infection. Lakunotomy using a laser beam is considered one of the least traumatic methods surgical treatment tonsils

Especially if the patient is experiencing an exacerbation of the disease, swelling and redness of the mucous membrane of the tonsils develops. The mechanism of the therapeutic procedure itself of this type

1. as follows: A surgeon who has permission to conduct surgical treatment using a laser and auxiliary equipment that provides a continuous flow of the laser beam incises the tonsil area local anesthesia
2. . This stage of treating tonsillitis with laser therapy is the most painful. The patient must endure the administration of an injectable pain reliever.
3. After the anesthesia takes effect and the patient loses sensitivity in the tonsil area, the surgeon begins to apply a laser beam to the surface of the tonsils. The specialist dissects the lacuna with a hot laser stream, in which there are excessive amounts of purulent plaques and a huge amount of pathogenic microflora. During these manipulations, purulent contents are simultaneously removed, pathogenic microbes

, and the doctor also gets the opportunity to immediately cauterize the operated area of ​​the throat in order to avoid excessive blood loss. Under influence The laser beam thermally excises the infected tissues and stops the chronic spread of bacteria throughout the body. After 2-3 days, due to catarrhal processes that develop in the tissues of the tonsils upon completion of the procedure, necrosis and rejection of the epithelial surface that has undergone laser carbonization occurs. This process slows down the complete healing of the operated tonsils for several days, but after 3-4 days the epithelial cells of the tonsils regenerate with the same intensity. Process full recovery and rehabilitation is purely individual and depends on the patient’s age, severity clinical picture acute or chronic tonsillitis that was diagnosed in the patient. In general, the optimal indicator for tissue restoration of operated tonsils using a laser is 10 days.

Who is recommended for laser treatment of tonsils for chronic tonsillitis?

Laser treatment of tonsillitis is an analogue of tonsillectomy, when bacterial infection has affected the tonsil tissue to such an extent that conservative treatment using traditional medications no longer brings the expected results therapeutic effect. Therefore, the otolaryngologist and the patient himself are faced with the question of complete removal of the tonsils using surgical equipment, or performing therapeutic manipulations with a laser, cauterizing the affected areas of the tonsils and preserving the functional abilities of this organ.

Laser therapy for tonsils is recommended in the following cases.

Frequent exacerbations If the patient chronic form tonsillitis, the disease exacerbates more often than 3 times a year, then this direct reading to perform laser sanitation of infected tissue areas of the tonsils. In case of absence of this treatment

, the number of exacerbations of tonsillitis will only increase every year.

Negative reaction to conservative treatment Therapy for chronic and acute tonsillitis always begins with the patient undergoing a course of medication, the use of potent antibacterial drugs, antiseptic solutions for gargling. If during therapy positive reaction is absent and the patient’s condition does not improve, sore tonsils

retain their swelling, pain, and purulent plaques continue to fill the lacunae of the tonsils, then this is a direct indication for laser therapy for tonsillitis.

Tonsillitis is an infectious disease that is most dangerous due to the development of its complications. In the event that the patient during comprehensive examination or based on complaints received from him about unsatisfactory health, diseases such as infectious myocarditis, rheumatoid arthritis, peritonsillar abscess, signs of blood poisoning, development of acquired heart disease, then with 85% probability we can assume that these pathologies were provoked precisely by the presence of chronic or acute form tonsillitis. The loss of precious time and the lack of treatment for tonsil tissue in the future threatens the patient even more acute development complications with damage to vital organs.

If a patient with tonsillitis has these concomitant pathologies, lacunotomy is one of the mandatory therapeutic methods for restoring the functionality of the tonsils in order to avoid their surgical removal.

Contraindications to the cauterization procedure

Lakunotomy has not only advantages and is different high efficiency in terms of its effect on the infected tonsils, but still has medical contraindications for use It is strictly prohibited to treat tonsils using a laser beam in the following cases:

• presence in the patient in the acute phase of development infectious disease with signs of profuse suppuration and the formation of multiple plaques (it is recommended to relieve the inflammatory process antibacterial drugs and only after that proceed to the lacunotomy procedure);
• development in the patient's body malignant tumors regardless of the type of cancerous tumor, as well as the area of ​​its localization (this prohibition is justified by the fact that laser irradiation can provoke more accelerated growth degenerated cells and then the tumor will begin to develop even more intensely);
• various diseases of the pancreas, as well as diabetes mellitus types 1 and 2 with increased or reduced level blood glucose;
• heart failure, lung diseases associated with a sharp reduction in the bronchial lumen and further development acute spasm of the respiratory tract;
• too much low level platelets in the blood, which provokes poor clotting blood, leads to frequent bleeding (lacunotomy itself is characterized by insignificant blood loss, since the laser not only removes the affected tissue of the tonsils, but also immediately cauterizes them, but still there is always a risk of hurting main vessel and suffer heavy blood loss);
• the presence of a state of pregnancy, as well as breastfeeding (these restrictions are justified by the fact that at this stage of a woman’s life any stressful situations, and lacunotomy is still an operation during which not a scalpel is simply used, but a hot laser beam);
• Children whose age ranges from 1 year to 10 years should also not undergo laser therapy for chronic tonsillitis.

These are the main medical contraindications that prohibit laser excision of infected tissues of the tonsils, since the development of much more dangerous complications is possible.

If these pathologies are present, the otolaryngologist selects other treatment methods for the patient, based on conservative therapy or traditional surgical intervention. This is already determined by the doctor on an individual basis.

How much does laser therapy for tonsillitis cost (average price per procedure) and is one procedure sufficient for results?

The cost of laser therapy for tonsillitis by sanitation of diseased tonsils using a laser beam directly depends on the city in which the procedure is performed, in the state or private clinic, as well as indirectly from individual pricing policy specialist who carries out this type of treatment. On average, the price range for lacunotomy is between 1200-1500 rubles per procedure. In most cases, it is not possible to completely get rid of inflammation in the tonsils in just one session and you may need to undergo 2-3 laser therapy procedures. Based on the results of completion of treatment, 10 days later the patient undergoes a follow-up examination and the doctor determines the need for a second course of therapy, or at this stage the treatment is completely completed and the patient has recovered.