RU2272660C2 - Method of treating patients suffering form nepholythiasis - Google Patents

Abstract

FIELD: medicine; urology.

SUBSTANCE: IR-range laser radiation is applied locally at projection of increment in kidney. 12 procedures of laser distant lithotripsy are given with the following frequencies: first to fifth procedures at 28-32 kHz, sixth to eighth procedures at 24 kHz, ninth to tenth procedures at 20 kHz, eleventh to twelfth procedures at frequency of 16 kHz. Shape of pulse for 1-2 procedures is rectangular, for 3-4 procedures - sinusoidal, 5-6 procedures - triangular, and 7-12 procedures - rectangular. All the procedures are performed till standard distant lithotripsy.

EFFECT: ability of reducing sizes of stone; reduced inflammatory changes in kidneys.

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Description

The invention relates to medicine, namely to urology.

Despite the known successes in the field of minimally invasive treatment of urolithiasis (ICD), the search for the least invasive methods of treatment is relevant. In this regard, of great interest is the method of complex drug and laser therapy for patients with chronic calculous pyelonephritis, both monotherapy and in combination with standard remote lithotripsy on the Urat-P apparatus. There are reports of the litholytic effect of low-energy radiation in the infrared range (Evstigneev A.R., Zaitsev I.M. 1999). Laser therapeutic devices operating on gallium arsenide, generating radiation with a wavelength of 0.89 microns, an average pulsed power of up to 5 W and a frequency of up to 33 kHz (Uley-2 KM Urat), cause the stones to vibrate and provide alternating light on them pressure and acceleration of loosening of calculi. According to this technique, the density of the calculus changes per unit time, depending on the frequency of the radiation and the shape of the supplied pulse. According to some authors (Maksutova G.Sh., Fomichev V.I., Eliseenko V.I. - 1999), variable acceleration is a factor that causes vibration of the stone and contributes to loosening of the structure of the stone.

This method is taken as a prototype ("Combined therapy of chronic cholecystitis using low-energy laser radiation in the visible IR range", in the collection of articles "Actual issues of clinical medicine"). The paper notes the positive effect of prolonged use of visible and IR laser radiation when exposed to the projection area of gallbladder stones.

The aim of the invention is to increase the efficiency of remote lithotripsy, reducing the incidence of postoperative complications.

The essence of the proposed method.

In the preoperative period, against the background of antibiotic therapy, 12 DLT sessions were performed on the Ulei-2 KM, Urat apparatus, the procedure was painless, performed daily for 15 minutes, the exposure frequency varied from 33000 to 16 kHz, the wavelength was 0.89 microns, pulse power - 5 watts. In our studies, the laser therapeutic complex "Uley-2 KM", "Urat" was used, with a frequency of 1 to 5 procedures 28-32 kHz, 6-8 procedure 24 kHz, 9-10 procedure 20 kHz, 11-12 procedure 16 kHz . Impulse shape: 1-2 procedures - rectangular, 3-4 sinusoidal, 5-6 triangular and from 7-12 rectangular. During treatment, the patient lies on his stomach, the effect is carried out by contact on the area of the projection of the kidneys along the rear axillary lines with an exposure of 15 minutes. Laser therapy was carried out against the background of drug therapy (antispasmodics, analgesics, antihypnosis sites, disinfectants, koplekson (xidifon), urolitics - kanefran, cyston, ginjaling, spilled) to 36 patients aged 25 to 68 years. The control group consisted of 20 patients who did not receive laser therapy. Monitoring the effectiveness of the treatment was carried out using x-ray examination, ultrasound of the kidneys, laboratory tests of urine, blood. Pain and functional symptoms were stopped in 26 patients of the main group from the 3rd procedure, the normalization of blood counts was noted in the 5-7 procedure. After a course of treatment, which included 8-12 daily procedures, there was a decrease in stone size, a decrease in inflammatory changes in the kidney parenchyma in 18 patients. When subsequent standard remote lithotripsy was performed on the URAT-P apparatus, it was possible to disintegrate the stones at a lower pulse power (from 14.0 to 17.5 W) and the number of pulses (up to 3000 imp.), A good fragmentation of the calculus was noted.

The use of the less invasive method Urat-2 KM "Hive" at the stage of preparation for standard DLT at Urat-P allowed to reduce the frequency of acute inflammatory complications from the kidneys by more than two times (up to 2.5% of cases). Ureter obstruction with calculus fragments was noted in 11.2% of patients. Hematuria was observed in less than 60% of patients. This result of DLT is most likely due to a decrease in the density of the calculus, finer fragmentation of the stone with a decrease in the power of the pulses and the total number of pulses, and a decrease in the activity of the inflammatory process.

An example of a specific implementation of the method.

Example 1. A patient was admitted with complaints of pain in the right lumbar region of a blunt nature, an increase in temperature to 38.2-38.5 °, changes in the urinary o / a (leukocytes, red blood cells, etc.). Sick for about 2 weeks. From the anamnesis it is known that it is sick for about 3 years.

The patient was examined, diagnosed with urolithiasis, stone of the right kidney (1.5 cm), chronic pyelonephritis. Antibacterial and symptomatic therapy has been started. At the same time, laser therapy was used using the Uley-2 KM Urat apparatus with a frequency of 1 to 5 procedures of 28-32 kHz, 6-8 procedure of 24 kHz, 9-10 procedure of 20 kHz, 11-12 procedure of 16 kHz. Impulse shape: 1-2 procedures - rectangular, 3-4 sinusoidal, 5-6 triangular and from 7-12 rectangular. During treatment, the patient lies on his stomach, exposure is carried out by contact on the area of the projection of the kidneys along the rear axillary line on the right with an exposure of 15 minutes. From the 3rd session, the temperature returned to normal, the inflammatory reaction decreased, by the 8th session the urine indices returned to normal. After 10 sessions, an ultrasound scan was performed - a decrease in the size of the stone (1.2 cm), a decrease in the inflammatory reaction of the kidney parenchyma were noted. On day 12, DLT was performed on the URAT-P apparatus (pulse wave power from 14.0 to 17.0 W, 2700 pulses in gentle and working mode), the calculus was completely disintegrated. Small fragments with a diameter of 0.1-0.2-0.3 cm independently go away independently. During a follow-up examination after 1 month, no stones were found in the urinary tract.

Example 2. The patient was admitted with complaints of paroxysmal pain in the right lumbar region, fever up to 39.5 °, nausea, vomiting, general weakness. During the examination, the patient was diagnosed with urolithiasis, multiple stones of the right kidney, hydronephrotic transformation on the right, exacerbation of chronic pyelonephritis. The patient underwent nephrolithostomy surgery on the right. Due to bleeding from the kidney, it was not possible to remove all the stones. There was only one calculus 1.1 × 0.9 cm in size. The patient in the mid-term period was given anti-inflammatory and symptomatic therapy using laser radiation from the Ulei 2 KM Urat apparatus with a frequency of 1 to 5 of the procedure 32 kHz, 6-8 procedure 28 kHz, 9-10 procedure 24 kHz, 11-12 procedure 20 kHz. Impulse shape: 1-2 procedures - rectangular, 3-5 sinusoidal, 6-8 triangular and from 8-12 - rectangular. During treatment, the patient lies on his stomach, the effect is carried out by contact on the area of the projection of the kidneys along the rear axillary line on the right with an exposure of 15 minutes. From the 4th session, the temperature returned to normal, the pain and inflammatory response decreased, and by the 10th session urine indices returned to normal. After the 11th session, an ultrasound scan was performed - there was a decrease in the size of the stone (up to 0.8 cm), a decrease in the inflammatory reaction of the kidney parenchyma, and a reduction in the renal pelvis. On day 12, a DLT was performed (the power of a pulse wave was from 13.8 to 17.8 W, 2800 pulses, in gentle mode), the calculus was completely disintegrated. Small fragments with a diameter of 0.1 to 0.3 cm independently and on the nephrostomy departed. During the follow-up examination after 15 days, no stones were found in the urinary tract, and the nephrostomy was removed.

The usefulness of the proposed method of treatment.

Remote lithotripsy (DLT), like any other surgical intervention, is not without complications, the frequency of which is due to the quality of the clinical examination of patients, the justification of indications for DLT, the adequacy of pre- and postoperative antibiotic therapy, the choice of the optimal technique and method of lithotripsy. The combined use of the Ulei 2 KM Urat and URAT-P devices makes it possible to significantly improve lithotripsy results and reduce the incidence of acute inflammatory complications from the kidneys and upper urinary tract, and significantly reduce the rehabilitation time of patients.

Information sources

1. Gres A.A., Mohort V.A., Dosta N.I., Nenartovich B.C. Remote shock-wave lithotripsy on the apparatus "Litostar Plus. Abstracts of the First Russian symposium on distance lithotripsy in urology. Moscow 1992, p.21-22.

2. Trapeznikova MF, Dutov VV Modern aspects of nephrolithotripsy. The plenum materials are right. Grew up. Society of Urology, Moscow, 1998, p. 259.

3. Bykov I. M., Rubtsova E. I. Qualitative characteristics of the density of stones and remote nephroureterolithotripsy. The materials of the plenum are right. Grew up. Society of Urology, Moscow, 1998, p. 284-285.

4. Farbirovich V.Ya., Golenda I.L., Khudyashov S.A., Minin V.V., Ovchinnikova V.V., Eisenach Y.V. Damaging effects of remote shock wave lithotripsy. J. Urology, 2001, p. 32-34.

5. Maksutova G.Sh., Fomichev V.I., Eliseenko V.I. Combined therapy of chronic cholecystitis using low-energy laser radiation of the visible and infrared ranges. Actual issues of clinical medicine. Moscow, 1999, p.81-84 - prototype.

Claims (1)

A method for the treatment of nephrolithiasis, including the use of laser radiation of the IR range locally on the projection of a calculus in the kidney, characterized in that they conduct 12 sessions of laser remote lithotripsy with a frequency of 1 to 5 procedures of 28-32 kHz, 6-8 procedure of 24 kHz, 9- 10 procedure 20 kHz, 11-12 procedure 16 kHz, pulse shape: 1-2 procedures - rectangular, 3-4 procedures - sinusoidal, 5-6 - triangular and from 7-12 - rectangular, and these procedures are performed before standard remote lithotripsy .