Method for the treatment of patients with stones in the lower third of the ureter
(57) Abstract:The invention relates to medicine, namely to physiotherapy, and can be used in the treatment of patients with stones in the lower third of the ureter. The method allows to cast out the fragments of stone "stone paths". The essence of the invention: on the background of the water load and antispasmodics consistently top-down influence on the area of projection of the lower third of the ureter rectally or vaginally first local vibration, and then the ultrasound pulse mode specific parameters through the day. 3 table. The present invention relates to medicine, in particular to urology, and can be used in the conditions of policlinic, hospital and sanatorium-and-Spa institution.In patients with urolithiasis widely used extracorporeal shock wave lithotripsy (ESWL). The most frequent complication is the formation of a "stone paths" from the debris of the destroyed stone and urinary sand, length 3-17 and more cm, at different levels of the upper urinary tract with full or partial obturation of them and the subsequent development of acute pyelonephritis, urosepsis, renal failure, etc. In the more important step after ESWL becomes the postoperative period, during which is necessary to achieve a spontaneous discharge of fragments of stone from the urinary tract in the coming days and parallel to the prevention of possible complications (acute pyelonephritis and others).Known methods of conservative removal of stone fragments in the form of "stone paths" of the upper urinary tract: local vibrotherapy, the total vertical vibrotherapy, large quantities of liquid, a decoction of the plant collection and the influence of the emitter of sound vibrations to the region of the projection gate diseased kidney. However, the above methods give relatively low percentage removal of stone fragments (40-87%).The prototype of the present invention is a method of treatment of patients with stones in the lower third of the ureter, providing a complex effect of physiotherapeutic factors, including pulsed ultrasound exposure intensity of 0.4-0.7 W/cm2within 5-7 minutes on background water load, spazmolitiki I I I.The disadvantages of this method of treatment are: the possibility of destruction of the mucous membrane of the rectum above the projection of the lower section of the ureter during the procedure due to the high intensity of the TEW-time exposure to them, the relatively low percentage removal of stone fragments from the lower third of the ureter (80%).The aim of the proposed method of treatment is the expulsion of fragments of stone "stone paths, increasing the effectiveness of treatment and reducing treatment time.This goal is achieved by the fact that intra-impact exercise consistently, first local vibration with frequency 6-16 Hz, an amplitude of 1-5 mm and a duration of 3-4 minutes, and after 5-10 min of ultrasound in pulsed mode with pulse duration of 10 MS, the intensity of 0.2-0.4 W/cm2and duration of 3-4 minutes through the day.This antispasmodics spasms of smooth muscles of the ureter, water intake increases urine output and promotes stone fragments in the ureter, and the local vibrotherapy and ultrasonic therapy increased motor function of the urinary tract and accelerate the passage of fragments of stone from the urinary tract.Indications for use of the proposed method of treatment are: the diameter of the stone or its separate fragments in the cross section does not exceed 7 mm, anatomical and functional changes in the kidney and ureter on the side localization concia stone, the passage of urine on macevil paths saved, calculus or the head part of the "stone road" is located in the ureter at the level of the 5th sacral vertebra or below it (according to program).Description of method of treatment.1. 4-6-fold method boiled drinking water based single reception 3-5 ml per 1 kg of body weight of the patient during the day.2. Welcome shpy in table 2. 2-3 times a day or baralgina 1 tab.3 times a day, or trigana 1 tab.3 times a day.3. Intracavitary (rectally, vaginally) serial impact down on the area of projection of the lower third of the ureter first local vibration with frequency 6-16 Hz, an amplitude of 1-5 mm and a length of 3-4 min and 5-10 min after ultrasound in pulsed mode with pulse duration of 10 MS, the intensity of 0.2-0.4 W/cm2duration 3-4 min of treatment of 3-8 treatments, every other day.After the procedure, rectum injected oil mixture consisting of paraffin oil 7 ml, carolynowoe oil or ointment Vishnevsky 7 ml, 2-4 PM in the vagina after the procedure, inserting tampons with syntomycin emulsion for 2-3 hoursP R I m e R 1. Patient C. weight of 70 kg, 8 h 30 min padevalt on the couch under the sacrum enclose wooden stand, vibrator wear rubber capsule (the condom) and grease it with vaseline. Then it is introduced into the vagina and set the head of the vibrator above the projection of the stone in the lower part of the ureter. Then the procedure is carried out in the following mode of operation: frequency 6 Hz, amplitude 1 mm and a length of 3 minutes In doing so, a slow, sliding, longitudinal movement, tightly clutching the head of the vibrator to the mucosa of the anterior-lateral wall of the vagina, in one direction sequentially from the lateral vaginal fornix to the outside of the urethra. Then after 5 minutes after it is affected by ultrasound in a pulsed mode of operation of the apparatus (10 MS), the intensity of 0.2 W/cm2duration 3 minutes to Produce the same slow, sliding, longitudinal movement, tightly clutching the head of the emitter to the mucosa of the anterior-lateral wall of the vagina, in one direction sequentially from the lateral vaginal fornix to the outside of the urethra. After the procedure, the vagina insert a tampon with syntomycin emulsion.Within days after the procedure, the patient is additionally takes inside in table 2. shpy 2 times and drinking water in 210 ml 3 Tabletka baralgina. At 11 o'clock in the treatment room patient laid on the couch, under the sacrum enclose his wooden stand, vibrator wear rubber capsule (condom), lubricate the mucous membranes of the anus and rubber capsule medical vaseline or vaseline oil. Then the vibrator with the capsule is introduced into the rectum, set his head above the place of localization of the head part "stone paths" in the distal ureter and firmly press it to the mucosa of the anterior-lateral region of the rectum. Then carry out the procedure in the following mode: oscillation frequency 16 Hz, amplitude 5 mm and the duration of the procedure 4 minutes immediately After the machine produce a slow, sliding, longitudinal movement, tightly clutching the head of the vibrator to the mucosa of the anterior-lateral wall of the intestine, in one direction sequentially from the level of the middle third of the rectum to the level of its lower third. Then after 10 minutes effect transrectal ultrasound in the pulse mode of the apparatus (10 MS), the intensity of 0.4 W/cm2duration 4 minutes to Produce longitudinal motion, tightly clutching the head of the emitter to the mucosa of the anterior-lateral wall of the rectum, in the same direction, consequently the ü (carolynowoe oil 5 ml + vaseline oil 5 ml).Within days after the procedure, the patient is optionally accepts inside baralgin 1 tab 2 times and boiled drinking water to 400 ml of 5 times.The proposed method of treatment was applied to 60 patients with fragments of shattered stone "stone paths" in the lower third of the ureter after extracorporeal shock wave lithotripsy of stones of the upper urinary tract.The proposed method of treatment contributed to the complete passage of fragments of stone from the lower third of the ureter in 58 (96,7%) and partial (reduced size "stone paths", its density and subsequent migration into the distal ureter) 2 (3,3%) of 60 patients after a single treatment approach. The size of the detached fragments of stone were in the range of 0.1 to 7.5 mmIn the presence of fragments of stone "stone path", size in the range of 0.1-5 mm, there was total discharge from the urinary tract in 100% of cases.On average, the course of treatment was required 3-5 procedures.After treatment of patients with the proposed method, it was also noted improvement objective symptoms and clinical and laboratory research.Therefore, after a comprehensive Leche is sustained fashion were treated with antibiotics and urocoptidae taking into account the sensitivity of microflora to the latest.As can be seen from the table, after treatment by the proposed method was statistically significant (P < 0.001) reduction of leukocytes and erythrocytes in the urine.Significant (P < 0.05) lower values of Tmaxaccumulation of radioreport kidneys and T1/2of the drug excretion from the kidneys to the end of treatment was associated mainly with the passage of fragments of stone from the lower third of the ureter and the improvement of its drainage function. After treatment, the Tmaxand T1/2remained high and did not reach normal values.Upon receipt of 50 patients with fragments of stone "stone paths" on programma significant or moderate expansion of the Cup-pelvis system (CLS) kidney and ureter and violation of the passage of the contrasting urine-side localization "stone paths". After a comprehensive treatment approach moderate expansion CLS kidney and ureter was observed in 1 patient.Thus, the proposed method for the treatment of patients with fragments of stone "stone paths" in the lower third of the ureter leaves a pronounced positive clinical effect in comparison with the known.The novelty of the proposed method lectim local vibration and ultrasound on the area of projection of the lower third of the ureter on the background of the measured reception boiled drinking water and spasmolytic drugs during the day, what contributes to the accelerated passage of fragments of stone from the urinary tract and reduce treatment time.The methods of procedures is simple, portability is good. The proposed method for the treatment of patients with fragments of stone "stone paths gives a high percentage of full discharge from the upper urinary tract. But the effectiveness of the treatment approach depends on the size of individual fragments of stone "stone path". In particular, after a single course of treatment approach for patients with fragments of stone "stone paths" in the lower third of the ureter in the presence of separate fragments, with sizes up to 7.5 mm in diameter, the effectiveness of the treatment was 96,7% and in the presence of individual fragments, with sizes up to 5 mm in diameter, the effectiveness of treatment 100%
When applying the proposed method of treatment, the average number of days of temporary disability is 3-18 days. In most cases, the treatment could be completed in a hospital. Method for the TREATMENT of PATIENTS WITH STONES IN the LOWER THIRD of the URETER, including rectal or vaginal exposure to ultrasound down on the area of projection of the lower third of the ureter on the background of the water n the achala local vibration with a frequency of 6 16 Hz, amplitude 1 to 5 mm and a length of 3 to 4 minutes, and after 5 - 10 min ultrasound in pulsed mode with pulse duration of 10 MS, the intensity of 0.2 - 0.4 W/cm2and lasting 3 to 4 minutes in a day.
FIELD: medical engineering.
SUBSTANCE: device has ultrasonic surgical instrument manufactured as staged ampoule-type concentrator which cylindrical part of greater diameter is coupled with the ampoule-type part by means of a stage, is resonator fixed in sealed casing and has at least one electromechanical element of piezoelectric type with contact surfaces connected to power supply generator. The electromechanical element is mounted on the resonator end located oppositely with respect to the stage. The resonator is fixed in sealed casing by means of axial compression on the casing part. The force applied between the stage and outer contact surface of electromechanical element is equal to a=(0,35-0.65)λ, where λ is the wavelength of longitudinal elastic resonator displacement coincident wave.
EFFECT: reduced device weight; high surgical instrument fatigue strength.
2 cl, 1 dwg