Method of treatment of patients with nephrolithiasis |
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IPC classes for russian patent Method of treatment of patients with nephrolithiasis (RU 2177354):
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(57) Abstract: The invention relates to medicine, in particular to urology. Comprehensively sequentially or simultaneously affect the calculus shock wave lithotripsy apparatus and sterile litolitic mixture for the destruction of stones in the kidney or the ureter into fragments of various sizes and forms for 5-16 h completely dissolved under continuous exposure to sterile litolitic mixture. Litolitic mixture consists of 400 ml of 5% glucose solution with 5000 units of heparin + 200 ml 3,66% solution trisamina + 400 ml of 0.2% solution of califona in 0.9% sodium chloride solution. In severe cases additionally used in transcutaneous laser therapy over the femoral artery in the inguinal folds. The result is improved efficiency of treatment of patients with nephrolithiasis by reducing the number of relapses, reduce the morbidity and reduction of terms of treatment of patients. 1 S. and 2 C.p. f-crystals. The invention relates to the field of urology and may be used to treat patients with urate and mixed urate-the oxalate nephrolithiasis. Known methods surgical removal of kidney stones and urinary tract, razrusheniyam medicines. To date, the results of the treatment of large stones kidney and long-standing ureteral stones were unsatisfactory: a high percentage of "open" surgeries, long-term (several months) treatment, a large number of complications, such as exacerbation of chronic pyelonephritis, ureteral strictures, cicatricial process in the kidneys. One of the early methods of treatment of patients with urate and mixed nephrolithiasis is oral citrate mixtures (Pytel J. A., Zolotarev I. I., 1995). The known method of hemolysis of uric acid stones in the kidneys and ureters of 0.1 molar solution of sodium bicarbonate through nefrologicheskie fistula /1/ through the washer calculus alkaline solution and dissolution. The main disadvantage of this method is the long duration of treatment (up to 21 days or longer) and the fact that its use is possible only with uric acid stones. It is known that trisamin or three-oxymethylene intravenously reduces the concentration of hydrogen ions and increases the alkaline reserve of the blood, eliminates acidosis; unlike sodium bicarbonate trisamin not increase carbon dioxide in the blood. He penetrates cell membranes is camping trisamin entirely by the kidneys unchanged. Apply trisamin with acute and chronic diseases involving metabolic or mixed acidosis: in shock, massive blood transfusions, extracorporeal circulation, burns, peritonitis, acute pancreatitis. The drug trisamin also shown in the treatment of poisoning by salicylates and sleeping facilities, as osmodiuretics influence and alkalization of urine helps to remove from the body weak acids. Trisamin is a white crystalline powder with a slight odor of amines. Easily soluble in water. The aqueous solution has an alkaline reaction, 3,66% aqueous solution of isoosmotic plasma; pH of 10.2 to 10.7. It is injected in the form 3,66% solution. The average dose of the solution for a patient weighing 60 kg 500 ml per hour (about 120 drops per minute). Maximum dose trisamina should not exceed 1.5 g/kg per day. Form release: in the form of sterile 3,66 % (0.3 M) solution in water for injection in containers made of polyethylene 250 ml. It is also known that oral dissolving small kidney stones composed of calcium oxalate, in recent years has been to apply a 2% solution of califona. The most effective developing in the treatment of the above categories of patients method of distance is the breaking of stones, starting with a Cup of departments and destroying in one session the stone weight, not exceeding 1,5-2,0 see effective When the first two sessions in therapeutic modes, this method allows you to complete the treatment of urolithiasis during 1-1,5 months /2/. This period is determined by the need to respect the intervals between sessions to restore the function of the kidneys. The ineffectiveness of 1-2 sessions using the maximum-energy shock-wave pulses, in any form Staghorn calculi stone advisable this method of treatment to stop. More promising in the treatment of Staghorn calculi nephrolithiasis is a combined method - a combination of endoscopic, or operative surgery with extracorporeal shock wave lithotripsy (ESWL) /2/. There is considerable promise in the treatment of large kidney stones and long-standing ureteral stones, urate and mixed chemical composition opened with the emergence of local dissolution of calculus. The closest technical solution, selected as a prototype, is a method of treatment of patients with nephrolithiasis, which consists in conducting lithotripsy with antibacterial therapy before and after it, ascolta with pulse frequency from 50 to 5000 Hz, the wavelength of 0.89 μm for 5 - 10 sessions in combination with analgesics at ultrasonic monitoring /3/. The main disadvantages of the prototype method are the long duration of treatment (up to 2-3 months), the need for multiple remote lithotripsy. Based on the foregoing, the invention aims to improve the efficiency of treatment of patients with urate and mixed nephrolithiasis by complex sequential or simultaneous exposure to ureteral stones extracorporeal shock wave lithotripsy and litolitic mixture by combining the destruction of ureteral stones by shock waves dissolving the obtained fragments litolitic mixture and transcutaneous laser therapy. The claimed method of treatment performed as follows: carry out a comprehensive sequential or simultaneous exposure to calculus shock waves of the apparatus of extracorporeal shock wave lithotripsy and sterile lethalities mixture, promoting the dissolution of stones, and the destruction of the stone in the kidney or the ureter into fragments of various sizes and shapes, thus reaching the restoration of patency of the ureter. In the process of destruction of stone or directly what korostil to 100 ml per hour sterile litolitic mixture, consisting of 400 ml of 5% glucose solution with 5000 units of heparin, 400 ml of 0.2% solution of califona (potassium-sodium salt oksietilidendifosfonovaya acid) in 0.9% solution of sodium chloride (NaCl) and 200 ml 3,66% aqueous solution trisamina, under the control of ultrasound scanning and pressure in the renal pelvis up to 24 cm of water column. In the resulting formed after lithotripsy fragments are completely dissolved within 5 to 16 hours of continuous exposure litolitic mixture, which depends on the mass of stone the size of 2 to 15 g and sizes of the resulting fragments after lithotripsy. At high density of the stone and its large size above the exposure is repeated. In severe cases additionally used in transcutaneous laser therapy over the femoral artery in the inguinal folds, and when the positive dynamics spend the first "magnetised" application areas of laser radiation within 7-10 minutes, then laser irradiation with doses not exceeding General therapy (2-4 Joule on the field) with the total duration of each procedure to 20 minutes. The hospital them. Acad. N. N. Burdenko were treated 37 patients in the method prototype and 18 patients in the duration of inpatient treatment ranged from 22 to 49 days and averaged 28 days, in the treatment of one patient were performed from 2 to 5 remote lithotripsy. In the treatment by the present method, the average duration of inpatient treatment was 15 days and it took 1-2 remote lithotripsy. Clinical example. Patient M., 46 years old, was treated in the office with 28.03.98, 11.04.98 was diagnosed with kidney stones, stone middle third of the right ureter. Ureterohydronephrosis right 2 tbsp. Chronic pyelonephritis in the phase of unstable remission. At admission the patient underwent needle nephrostomy with subsequent single ESWL apparatus Lithate-P", in which the stone was fragmented. During lithotripsy and within 3 days after it was conducted introduction to nefrologicheskie drainage specified drug mixture and laser irradiation by the above method, the total period of continuous introduction of the mixture amounted to 14 hours. As a result of the treatment of the stone fragments were dissolved, the patency of the ureter is completely restored. The patient was discharged with recovery. The inventive method of treatment improves the efficiency of treatment of patients with urate and mixed stone, SOA and reduce the invasiveness of the treatment. Sources of information1. F. Bruel, I. E. Altwein, B. Schneider. Local hemolysis occlusion caused by uric acid stones /Ukr. "Urology and Nephrology", N 1. - 1988. - Leipzig, GDR. - S. 613-622. 2. K. A. Lopatkin, N. To. Zernov. Extracorporeal shock wave lithotripsy 10 years later // Materials of the Plenum of the all-Russian society of urologists. - Ekaterinburg, 15-18 October 1996, M., 1996. - S. 313-322. 3. B. N. Avdoshin, M. I. Andryukhin, Ahmed El-Candoco. The effectiveness of magnitolazeroterapii in the treatment of patients with urolithiasis after extracorporeal shock wave lithotripsy // Materials of the Plenum of the all-Russian society of urologists. - Ekaterinburg, 15-18 October 1996, M., 1996. - S. 323-324 (prototype). 1. Method of treatment of patients with nephrolithiasis, which consists in conducting lithotripsy with antibacterial therapy before and after it, in combination with analgesics ultrasound monitoring, characterized in that the perform integrated sequential or simultaneous exposure to calculus through a combination of destruction of a stone in the kidney or ureter shock waves through the apparatus of extracorporeal shock wave lithotripsy and stereophone in 0.9% solution of sodium chloride and 200 ml 3,66% aqueous solution trisamina when the pressure in the renal pelvis not more than 24 inches of water column, and in the process of destruction of stone or immediately thereafter in the kidney or ureter enter through nephrostomies tube or ureteric catheter specified litolitic mixture with a speed of 100 ml/h and continuously exposed for 5-16 h litolitic mixture. 2. The method according to p. 1, characterized in that the high density of stone and large sizes above effects repeat. 3. The method according to p. 1, characterized in that in severe cases additionally use a transcutaneous magnetic-laser therapy for femoral artery in the inguinal folds.
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