RU2115371C1 - Method of kidney cysts treatment - Google Patents

Abstract

FIELD: medicine, in particular, urology. SUBSTANCE: method includes bringing of aspirating needle transcutaneously to cyst membrane; introduction through its opening of laser light guide; crosswise dissection of cyst membrane; concurrent coagulation of cyst edge with laser radiation under pulse-periodic conditions with pulse frequency of 100 Hz and power of 60 W: evacuation of cyst contents; installation of draining tube. The procedure is performed under control of ultrasonic testing. EFFECT: reduced injury and provision of prophylaxis of disease recurrence in treatment of kidney cyst.

Description

 The invention relates to medicine, namely to urology.

 A known method of surgical treatment of kidney cysts (N. A. Lopatkin, E. B. Mazo "Simple kidney cyst", Moscow, Medicine, 1989, pp. 82-83), including dissection of the skin and muscles for 10-14 cm, the allocation cysts and excision of its walls with subsequent tamponade of the cavity formed by perirenal fiber.

 The known method is traumatic, carried out under general anesthesia, often accompanied by complications such as the formation of postoperative hernias, bleeding, the attachment of a purulent infection.

 There is also known a method of treating kidney cysts, which consists in puncture of the cyst with a needle and evacuation of its contents (“Diapeutics in urology” edited by A.V. Morozov, Moscow, IPO “Polygram”, 1993, pp. 60-82).

 The method has received widespread in recent years, due to its low invasiveness. However, in 30-80% of cases, a relapse occurs.

 As a prototype, a method has been adopted for treating kidney cysts by endoscopic marsupialization (A.G. Martov, “Diapeuctics in Urology”, Moscow, 1983, pp. 171-174).

 The essence of the method lies in the fact that under the control of ultrasound (ultrasound), a cyst is punctured with a needle with aspiration of a small amount of its contents for cytological examination. Then, a contrast agent and a conductor string are inserted into the cyst along the needle. The percutaneous canal is expanded to size N 24 on the Charlier scale with teflon telescopic dilators. After that, an endoscope is inserted into the cyst cavity. Pieces of tissue are taken for histological examination from areas suspicious for neoplasm using biopsy forceps. Normally, the inner wall of the cyst is covered with a yellow mucous membrane, injected with vessels intersecting each other in different directions. Using a contact cystoscope microscope, it is possible to conduct an intraoperative morphological examination of the cystic wall. Next, an incision is made on the wall of the cyst using a direct or hook-shaped endoscalpel, starting from the inside and continuing until the nephroscope leaves the cyst. Intervention is completed by placing a drainage tube in the cyst cavity for 2-3 days. With very large cysts, one of the sclerosing agents (alcohol, tetracycline) is administered through the cystome.

 However, the known method has several disadvantages.

 The expansion of the percutaneous canal may be accompanied by infection in the wound, hematuria. The duration of the procedure is 60 minutes or more, which complicates the manipulation, since immediately after the incision, the tightness of the "cystic sac" is impaired. Possible relapse of the disease.

 The objective of the invention is to provide a highly effective method of treating kidney cysts, which helps to prevent possible complications and the occurrence of relapse of the disease.

 The essence of the invention lies in the fact that in a method of treating kidney cysts, including dissection of the cyst membrane, evacuation of its contents, followed by the installation of a drainage tube, the puncture needle is transdermally brought to the cyst membrane, a laser light guide is introduced through its lumen, and a cross-section of the cyst membrane is performed simultaneously coagulation of its edges with laser radiation in a pulse-periodic mode with a pulse frequency of 100 Hz and a power of 60 W, and the entire procedure is performed under ultrasound control go study.

 Using the invention allows to obtain the following technical result.

 The method is highly effective. It allows you to prevent possible complications associated with direct surgical intervention and endoscopic marsupialization of the cyst.

 The duration of one procedure is 15-30 minutes, and the duration of the patient’s stay in the hospital is reduced to 5-6 days. In some cases, the procedure can be performed on an outpatient basis.

 In this case, complete evacuation of the contents of the cyst to the perinephral space is achieved, which eliminates the possibility of relapse of the disease.

 The technical result is achieved by bringing the laser fiber along the lumen of the puncture needle to the wall of the cyst under the control of ultrasound. A cross-shaped dissection of the cyst membrane allows you to completely empty its contents. With this dissection, simultaneous coagulation of the edges of the dissected wall occurs.

 The method is as follows.

 The whole procedure is carried out under the supervision of an ultrasound scan (Apparatus BK Medical N 1045).

 The patient is laid horizontally on the stomach. The surgical field is treated with 3% iodine solution. Choose the puncture site and the direction of the puncture stroke so that the needle does not pass through the parenchyma of the kidney or pass it bypassing the pelvis. The depth of injection is determined by measuring the distance from the skin surface to the center of the cyst according to the ultrasound image on the screen of the device. According to the puncture course, local anesthesia is performed with 0.25% novocaine solution in a dose of 20.0 ml. Then the skin is cut to 3 mm and the Leott puncture needle is inserted through the parenchymal space to the cyst membrane under observation on a television monitor. After bringing the tip of the needle to the cyst membrane, the mandrin is removed. A laser light guide is introduced through the lumen of the needle. Use the domestic laser system "Laska". A cross-sectional dissection of the cyst membrane is carried out with simultaneous coagulation of the edges by laser radiation in a pulse-periodic mode with a pulse frequency of 100 Hz and a power of 60 watts. After that, the laser light guide is removed. Microdrainage with a diameter of up to 2 mm is installed in the cyst cavity, which is fixed to the skin with a silk suture after complete evacuation of the contents of the cyst. Drainage is removed for 2-3 days under the supervision of ultrasound.

 Example. Patient N., 35 years old. He entered the Department of Urology, University named after S.P. Botkin 02/12/97. with a diagnosis of cyst of the right kidney (according to ultrasound and x-ray examination). 02/15/97. the patient underwent cyst treatment according to the proposed method.

 After horizontal laying of the patient on the stomach, the surgical field is treated with 3% iodine solution. After selecting the puncture site, the direction of the puncture stroke and determining the depth of injection according to the puncture stroke, local anesthesia was performed with 0.25% novocaine solution in a dose of 20.0 ml. The skin was cut by 3 mm, after which the Leott puncture needle was inserted through the parenchymal space to the cyst membrane. The mandrin was removed and a laser light guide was inserted through the lumen of the needle. Used a laser installation "Weasel". A cross-sectional dissection of the cyst membrane was carried out with simultaneous coagulation of its edges by laser radiation in a pulse-periodic mode with a pulse frequency of 100 Hz and a power of 60 watts. After that, the laser fiber was removed, and microdrainage was installed in the cyst cavity, which was fixed to the skin with silk sutures after the cyst was completely evacuated. Drainage removed on the 3rd day. All manipulations were performed under ultrasound guidance. The postoperative period went smoothly without complications. The patient was discharged on the 5th day after the operation. The observation period is 3 months. No relapse.

Claims (1)

 A method of treating kidney cysts, including dissection of the cyst membrane, evacuation of its contents, followed by the installation of a drainage tube, characterized in that a puncture needle is brought to the cyst membrane percutaneously, a laser light guide is introduced through its lumen, and a cross-sectional dissection of the cyst membrane is performed with simultaneous laser coagulation of its edges radiation in a pulse-periodic mode with a pulse frequency of 100 Hz and a power of 60 W, and the entire procedure is performed under the supervision of ultrasound.