RU2633594C1 - Method for urolithiasis treatment by percutaneous nephrolithotripsy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: for percutaneous nephrolithotripsy, a housing is introduced into the kidney luminal system. Prior to stone destruction, polypropylene mesh cones are directed and arranged in the kidney cups necks or ureteropelvic junction. Cones are equipped with traction strings. After crushing, the mesh is removed by pulling the strings.

EFFECT: prevention of fragments migration during crushing by percutaneous nephrolithotripsy, improved efficiency of urolithiasis treatment of due to more complete stone removal, without leaving residual fragments of stones, prevention of recurrence.

1 ex, 2 dwg

Description

The invention relates to medicine, in particular to urology, and for the treatment of urolithiasis by percutaneous (entangled) nephrolithotripsy.

The percutaneous endoscopic technique for the treatment of urolithiasis began to be applied due to the introduction in 1953 of Yoodwin percutaneous puncture nephrostomy with hydronephrosis. In essence, it was the first step in the development of the percutaneous technique for treating nephrolithiasis. Since then, the procedure for puncture nephrostomy has changed significantly and enriched the capabilities of modern urology in the treatment of kidney stones.

In 1976, Femstrom and Johansson reported the first successful removal of kidney stone by a nephrostomy. Subsequently, Kurth et al. (1977) used an ultrasonic lithotripter to destroy and remove coral-like stones by small diameter nephrostomy drainage.

Swollen (or percutaneous) nephrolithotripsy is a minimally invasive method for removing urinary stones, in which the calculus is removed from the kidney through a “tube” inserted into the kidney through a small hole in the back.

A known method for the treatment of urolithiasis by entangled nephrolithotripsy, including the introduction into the cavity system of the kidney of the channel through which a tool with a stone-destroying probe is inserted into the kidney (electronic resource http://lurolog.ru/services/perkutannaya-nefrolitotripsia.html).

As a stone-destroying tool, a laser fiber, an ultrasonic or pneumatic probe can be used.

The disadvantage of treating urolithiasis with entangled nephrolithotripsy is that during crushing in the kidney, the stone can fly up through the cavity system of the kidney and expensive equipment - flexible nephroscopes is needed to find it, even with them it is not always possible to find fragments that dooms the patient to early relapse.

The technical result to which the present invention is directed is to increase the effectiveness of percutaneous treatment of urolithiasis by more complete removal of the stone without leaving residual fragments of stones and preventing the occurrence of relapses.

The specified technical result is achieved by the fact that in the method of treating urolithiasis by entangled nephrolithotripsy, comprising introducing a casing into the cavity system of the kidney, along which a stone-destroying probe is inserted into the kidney, according to the invention, through the same casing, before the stone is destroyed, in the isthmus of the kidney cups or a cone-shaped polypropylene mesh with retraction threads is inserted into the pelvic-ureteric segment, and after crushing, the mesh is removed by pulling by the threads.

The characteristics of the cone-shaped polypropylene mesh, hereinafter referred to as “Stopper”, are as follows: the cone is made of “ESFIL Standard” (http://www.lintex.ru/page l60.html), the diameter of the base of the cone in open form is 15 mm, in closed 2 mm, the length of the cone - 15 mm, the length of the retraction threads - 200 mm

The installation of a polypropylene mesh in the form of a cone in the neck of the cups or in the ureteropelvic segment prevents the migration of stone fragments during crushing.

A method for the treatment of urolithiasis by entangled nephrolithotripsy is illustrated by drawings, where:

in FIG. 1 shows a cone-shaped polypropylene mesh with retraction threads;

in FIG. 2 shows a cone-shaped polypropylene mesh installed in the isthmus of the kidney cups through the casing.

A method of treating urolithiasis by entangled nephrolithotripsy is as follows.

The procedure is carried out under intubation or epidural anesthesia, which makes it completely painless. First, the doctor performs cystoscopy and catheterizes the ureter on the side of the operation. Then the patient is transferred to the stomach, and a roller is placed under the stomach (this is necessary for a safer introduction of the nephroscope away from large vessels, intestines, pleura). Having carefully established the location of the kidney stone 1, under the x-ray or ultrasound control, a puncture of the pyelocaliceal system is performed.

After this, a cup is selected through which the stone can be removed most conveniently. Next, a casing 2 is installed in this cup - a special channel through which a nephroscope is installed in the kidney - an endoscope for the kidney (not shown in the drawing). Endocopic forceps (not shown in the drawing) are inserted into the working channel of the nephroscope, which capture the polypropylene cone-shaped mesh 3, hereinafter referred to as “Stopper”, from the outside and enter the cavity system through the casing 2 and install it in those places where fragments (cup isthmuses can escape , ureteropelvic segment), so that the retraction threads 4 remain outside the casing 2. After installing the “Stopper” 3, endocopic forceps are replaced by a probe (not shown) ultrasound / pneumatic / laser for azrusheniya stone. Then there is a direct grinding and removal of stones under the control of vision, while "Stopper" 3 prevents accidental migration of fragments. After removal of all stones, drainage is established (nephrostomy / ureteral catheter / internal ureteral stent).

A method for the treatment of urolithiasis by entangled nephrolithotripsy with the use of "Stopper" is illustrated by a specific example of its implementation.

Example.

Patient C, 56 years old. Diagnosis: ICD, a large stone of the right kidney. Was admitted to the hospital with complaints of periodic acute pain in the right lumbar region. In urinalysis - red blood cells up to 50 in p / sp.

Ultrasound: in the pelvis of the right kidney hyperechoic formation up to 2.5 cm in size with an acoustic shadow.

With multispiral computed tomography (MOST): in the projection of the pelvis of the right kidney, a calculus is determined with a size of 2.5 × 2.2 × 2.6 cm and a density of 1320 HU. The patient performed percutaneous (mixed) nephrolithotripsy on the right. Puncture was performed through the upper cup under x-ray control. With nephroscopy, the calculus was visualized in the pelvis of the right kidney. To prevent fragments from migrating to the ureter, the Stopper is installed through the casing into the ureteropelvic segment. The stone is destroyed using an ultrasound probe. Fragments accumulated in "Stopper", removed with forceps. After the final inspection, “Stopper” is removed for retraction threads. On the casing in the pelvis set nephrostomy 8.5 Sn. Nephrostomy removed on the 2nd day. The patient was discharged on the 3rd day. According to the MSCT of the kidneys, performed after 24 hours, there are no residual stones in the right kidney.

Using the proposed method for the treatment of urolithiasis by entangled nephrolithotripsy using the Stopper polypropylene cone, the surgical treatment can be more effective due to a more complete cleansing of the kidney from the stone without leaving residual fragments, which in turn will prevent the occurrence of early relapses.

Claims (1)

A method of treating urolithiasis by entangled nephrolithotripsy, comprising introducing a casing into the kidney system, using which a stone-destroying probe is inserted into the kidney, characterized in that through the same casing, before the stone is destroyed, into the isthmuses of the kidney cups or into the ureteropelvic segment a cone-shaped polypropylene mesh with retraction threads is inserted to prevent fragment migration during crushing, and after crushing, the mesh is removed by pulling on the threads.

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