Sinaiko I. Optimization of combined treatment of patients larynx cancer pathogenetically by pathogenetically-based prevention of local inflammatory complications

The dissertation work is devoted to the problem of optimizing the treatment of patients with laryngeal cancer T1-2N0-1M0 by pathogenetically substantiated prevention of disorders of microcirculation in the larynx and in the parameters of the pro- and antioxidant systems in the stages of the combined treatment on the basis of new scientific evidence on their role in the emergence of local inflammatory complications, and based on the results clinical data of 122 patients. Conducted analysis of the frequency of the local inflammatory complications in 61 patients with laryngeal cancer T1-2N0M0 control group (CG) with the traditional accompaniment of the postoperative period found that hondroperihondritis of larynx arose in 15 patients (24,5%), and this led to a desynchronization components of the combined treatment in 14,7% and the reduction the effect of their treatment. Two-years survival rate was 78,6%. The analysis of data of patients CG integrated intraoperative LDF-metry of microcirculation in perichondrium of the thyroid cartilage showed that the increase in value of the index of the normalized amplitude of the tidal range above 14,51 pf.od. is accompanied by venous stasis and hondroperihondritis and requires correction by venotonic drugs. It has been established that CG patients with postoperative radiotherapy had increased levels of markers of oxidative stress: AFG (r = +0,72, р<0,05), CCF (r = +0,66, р<0,05), decrease in the content of endogenous antioxidants, microcirculation disturbance in vasospastic type that required antioxidant, vasodilatory and endotelioprotective therapy. The system of risk prediction of local inflammatory complications and pathogenetically substantiated pharmacocorrection of violations in the state of pro- and antioxidant systems and the associated changes in microcirculation on the stages of the combined treatment in the study group allows to reduce the incidence of laryngeal hondroperihondritis to 18,1% (р<0,05) and increase the rate of the 2-years-old survival on 14,8% (р<0,05) as compared with the control group.