Study Of Clinical Curative Effect And Mechanism On The Nd:YAG Treatment Of Tonsillitis

Palatine tonsils are located on the strategic site at an entrance ofboth the gastrointestinal tract and airways. And it is the gate throughwhich the microorganism such as the bacterium and virus invadesorganism. So the tonsillitis is one of the most common clinicaldiseases of the E.N.T. The tonsilectomy is one of the most ancientbut the most common surgical operations in E.N.T. Although thetechnique and the difficulties of the surgical operation are not high,but the complications such as the blood after operation oftenoccur,and the serious even endangers patient's life. And how tomitigate the pain after the operation is also the problem that theclinic pays attention to. Palatine tonsils as the immunity organ of theorganism has the physiology function of presenting antigen, theformation of antibody, the immunological memory and cellularimmunity. Therefor the reservation of palatine tonsils have importantclinical meaning. In recent years with the continual development ofthe research and of successful manufacture of the new laserdevice, with the development of the research of the interactionbetween the laser and the biological tissue,the international lasermedicine obtained the quick development. The laser has shown thesignificant superiority in the treatment of E.N.T. In recent years wetreated acute and chronic tonsillitis with laser by exposure, bleach,solidify the tonsil surface and crypt insert etc., obtaining the goodcurative effect.Objective: Pass the clinical case observation and to thetonsillitis sufferer the before and after Nd:YAG laser treatment theT lymphocyte subpopulation dynamic state in peripheral bloodmeasure, provide the theories for the clinical application that thelaser cures the tonsillitis according to.Method: We divided the research object to two groups. One isthe patients of tonsillitis ,another is the control group which is fromhealthily normal person who dedicate blood. The group of tonsillitispatients were treated by the 100-II type YAG medical laser machinewhich is produced by Wuchang laser equipments factory, thewave-length is a 1.06 um. The patients takes the seat, using 2%tetracaine to spray to swallow in order to mucosa surface anaesthesiathree times, the power is generally between 10W-15W, exposure,bleach, solidify the tonsil surface and crypt insert etc. to treat thetonsillitis. The laser performance time length and the method thatchoose to use according to the changes of pathogenetic condition.The group of chronic tonsillitis at 1day before treatment, and 2weeks after treatment were taken the vein blood 2ml, anticoagulationwith heparin, the control group were taken the vein blood 2mlequally, anticoagulation with heparin. T lymphocyte subpopulationwere detected with flow cytometry. The FCM for FACSCalibur typewas produced by American company of BD, and the reagent whichwere produced by the company of eBiosciense were monoclonalantibody which is CD3FIFC/CD4-PE , CD3FIFC/CD8-PE ,CD3FIFC/CD16+56-PE. The examination data means with the x ± s,the data carried on the Student's t-test of significance.Results: I. Clinical observation result: The patients suffered alittle pain and had no blood in the process of the treatment by laser,and the cure time is short. The patients had the ache within the 24hours after treatment, but the ache obviously relieve after 24 hours,and most patients' ache disappeared. The laser have the function toobviously reduce the body temperature for the patients who had ahigh fever. Only one case whose temperature steped up after thetreatment by laser, but the temperature recover to the normal levelafter 24 hours. The canous pseudomembrane formed on the tonsillarsurface and the point that the laser inserted, which can generallyamotic within 5-7 days. For the acute episode of the chronictonsillitis the constitutional symptom and local symptom obviouslyrelieved after once treatment by laser, degrading the temperature,relieving the pharyngalgia, decurtating the course of disease, anddecreasing the application of the antibiotic. The paroxysmalfrequency of the tonsillitis have decreased for the patients of thechronic tonsillitis. There is only one case who appeared pharyngalgiaagain after two months within one year follow-up visit, but he didnot have fever, and the surface of the tonsil had synathresis but didnot suppurate. The patient have not relapse up to now after he treatedby laser again. Other cases all die not relapse. II. The check result ofthe laboratory: The level of CD3+ , CD4+ 及 CD4+/CD8+ in theperipheral blood of the chronic tonsillitis patients is significant lowerthan control group(P<0.01), and the level of CD8+ is obviouslyhigher than the control group(P<0.05). After laser cured, the level ofthe CD3+ , CD4+ 及 CD4+/CD8+ obviously upgrades thanpretherapy(P<0.01), and it reaches to the normal level(P>0.05). Thelevel of CD8+ obviously decreases than prior treatment (P<0.01), andit approaches to the normal level (P>0.05).Discussion: Our findings show that the level of CD3+,CD4+及CD4+/CD8+ in the peripheral blood of the chronic tonsillitispatients is significantly lower than the control group. This explainsthat the cellular immune function of the patients who were irritatedby chronic tonsillitis is inhibited. But through the laser treatment theabove-mentioned index obviously goes up and attains the normallevel. The laser treatment relieve the condition that the cellularimmune function of the patients is inhibited and recover it to thenormal level. Nd+:YAG laser device is a kind of more frequentlyused in the medical science. Because the laser ion of the Nd+:YAGcrystal is four energy level structures, Nd+:YAG laser has theadvantage of low threshold. Moreover, the crystal of YAG has thegood thermoconductivity, which can make the laser continuouslywork under the indoor temperature or can work with the highrepetatus frequency. These are tow main characteristicses ofNd+:YAG laser. Nd+:YAG laser is the near infrared ray invisiblelight of the wave-length 1.06um, which is exactly at the bestpenetration scope of the optical fiber. Therefore easy transmissionand convenient operation are the preponderance compared theNd+:YAG laser with the carbon dioxide laser, moreover thepenetrativity and the function to clot blood are better than carbondioxide laser. When convergent laser beam irradiate upon theorganization, it can convert light energy into the heat energy inseveral millisecond, make the protein in cells denature, make themoisture content ponderosusly loss, and lead to cell death, tissuesyneresis and pneumatolysis to achieve the goals of treatment. Thefrequently morbidity of the acute tonsillitis make the body'sresistance low ,the bacterium and virus etc. accumulate and breedin the crypt, the long-term exposure with the epithelium mucosae oftonsil cause the allergy and damage the tonsil. This is the mainetiopathogenisis of the chronic tonsillitis. Nd+:YAG can create hightemperature in several millisecond at the part of the irradiated site, tokill the pathogenic bacteria in the crypt. It makes the damagedepithelium mucosae in the crypt and the tissue solidify andpneumatolysis with the method of irradiation, albifaction, solidifyand insertion in crypt etc., to achieve the purpose of killingpathogenic bacteria, blocking crypt and cleaning focus of infection.Because as an immune organ tonsil has its special physiologicfunction, especially for the children whose other immune organ invivo have not yet matured, the tonsil's function of immune organ ismore important. Therefore the application of Nd+:YAG laser to treatthe tonsillitis appears more important in the treatment of children.Conclusion:1. The advantage of Nd+:YAG laser treatment oftonsillitis:The laser treatment causes smaller physiological andpsychic trauma on patients. And there is smaller pain during andafter the treatment, no blood during the treatment. The time of thelaser operation is short, and the function of the tonsil is betterreserved. 2. The immunological change of the Nd+:YAG lasertreatment: The level of CD3+,CD4+及CD4+/CD8+ in the peripheralblood of the chronic tonsillitis patients is significantly lower than thecontrol group. This explains that the cellular immune function of thepatients who were irritated by chronic tonsillitis is inhibited. Butthrough the laser treatment the above-mentioned index obviouslygoes up and attains the normal level. The laser treatment relieve thecondition that the cellular immune function of the patients isinhibited and recover it to the normal level.3. The clinical curativeeffect of the Nd+:YAG laser treatment of the tonsillitis: For theacute episode of the chronic tonsillitis the laser treatment can healthe fever, alleviate the ache, eliminate inflammation, kill thepathogenic bacteria, shorten the course of disease and reduce theapplication of the antibiotics. For the chronic tonsillitis the lasertreatment can reduce the relapse frequency and even can freedomfrom relapse,obviate the tonsillectomy, reserve the function of thetonsil.