Using the photodynamic effect in surgery

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Introduction. The method of photodynamic therapy (PDT) is relatively new. It is most widely used in the treatment of various oncological formations. Recently, research has begun on the use of this therapy in surgery and many other medical fields. PDT is a modern, low-traumatic method of treating a large number of diseases in gynecology, gastrosurger, purulent surgery, dermatology, otolaryngology, clinical immunology and allergology, combustiology, orthopedics, maxillofacial surgery, endocrinology and ophthalmology. Singlet therapy is a treatment method that is based on the selective destruction of rapidly dividing cells under the influence of a special form of oxygen, which is formed when a photosensitizing substance (PS) is activated by directed light.

 Singlet oxygen is formed in tumor cells in much larger quantities than in healthy tissue, which leads to high efficiency of photodynamic effect in the treatment of cancer. Most often, photodynamic therapy uses red light, but the effectiveness of PDT under the influence of ordinary sunlight has also been proven. Photosensitizers are substances whose main function is to increase the sensitivity of biological tissues to light, as well as participate in reactions that result in the formation of singlet oxygen.

The goal. Analysis of the possibility of using singlet therapy in different areas of surgical activity.

Materials and methods. The material for this study was a selection of articles by specialists in various fields of surgery including purulent, maxillofacial, and oncological surgery over the past 5 years.

Results. The mechanism of photodynamic effects on microorganisms includes the following effects. When PS enters the tissue, it is evenly distributed. Next, exposure to light from the laser electrode occurs. Under the influence of which, a reaction begins, the result of which is singlet oxygen. Oxygen in this form has high antimicrobial activity. At the same time, it has high reactivity and can transform into hydrogen peroxide or compounds containing hydroxyl radicals [1].

Photodynamic therapy has proven effective in the treatment of: vascular malformations, due to the destruction of the vascular endothelium; varicose veins, melanomas, various tumor formations. PDT has shown high efficiency in the destruction of herpes viruses, as well as the human papillomavirus (HPV) in the treatment of cervical cancer (CC). Using the photodynamic effect, sanitation of the abdominal cavity of patients with abscesses was carried out, where it proved its effectiveness. Photodynamic therapy is also used as a treatment of COVID-19 [2]. Over the past 5 years, there has been a rapid increase in the number of studies studying the effect of PDT on the growth and development of trophic ulcers, which arise as complications against the background of such diseases as diabetes mellitus type 2. Treatment of patients with peptic ulcer disease included both PDT using photoditazine in gel form as a photosensitizer, and combination with plasma therapy.

The result of such therapy was complete cleansing of the wound from destroyed tissue and decay products, restoration of blood flow at the site of injury, stimulation of fibroblast proliferation, local acceleration of phagocytosis, maturation of young tissue cells and re-epithelialization of the defect after 12-15 days. In studies regarding the use of PDT in the treatment of oncological formations in lung tissue, an increase in the frequency of use of this technique is noted. This is due to the relative accessibility of this method, a high level of effectiveness in treatment, as well as a minimally traumatic effect on lung tissue. PDT in the treatment of lung cancer is used not only in palliative therapy, but also to eliminate the symptoms of shortness of breath, hemoptysis and airway obstruction. Photodynamic therapy, due to the small number of side effects, can be combined with conventional treatment methods, such as radiation and chemotherapy, and surgery. PDT is also successfully used as an independent method for treating lung cancer [3]. Despite the large number of indications, PDT has a number of conditions in patient’s health when its use is contraindicated. Among the relative contraindications for use, many experts include the following conditions: anemia, individual intolerance by the patient’s body to a photosensitizing drug or its components, acute or chronic liver failure, as well as kidney disease, since these organs take part in the removal of the photosensitizer. PDT is contraindicated in pregnant women and patients during lactation. Porphyria and systemic lupus erythematosus are diseases for which the use of singleton therapy is unacceptable. In various terminal conditions, cerebrovascular accidents and other local hemodynamic disorders, the use of photodynamic therapy can be fatal [4].

Conclusion. Research on the use of photodynamic therapy in various areas of healthcare is of particular interest to specialists in various fields of medicine, surgery is no exception. The set of effects obtained when using this technology provides a wide range of possibilities in its use. Further study of this method and the discovery of new, more effective photosensitizers will expand the list of areas of application of PDT, as well as increase the effectiveness of the action.

About the authors

Vladimir Alexandrovich Zhdanov

Voronezh State Medical University named after N.N. Burdenko

Email: vladimir.zhdanov.1986@mail.ru
ORCID iD: 0000-0002-2407-4974
SPIN-code: 8899-0657
Russian Federation, 394036, Voronezh, st. Student, d. 10.

Alexander Alekseevich Andreev

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: sugery@mail.ru
ORCID iD: 0000-0002-5242-6105
SPIN-code: 1394-5147
Russian Federation, 394036, Voronezh, st. Student, d. 10.

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