RU2286111C2 - Method for treating renal carbuncle - Google Patents

Abstract

FIELD: medicine, urology.

SUBSTANCE: during operation one should apply a laser light guide directly into carbuncular area and fix it to nephrostomic drainage which should be fixed to patient's muscle and skin together with the light guide. It is necessary to apply He-Ne laser at wave length being 0.63 mcm, power of 40 mW/sq. cm and 2 mW at light guide's end. Laser irradiation should be carried out for 5 min/d for 10 d. The innovation provides light guide's fixation to nephrostomic drainage that prevents it against damage during the whole period of therapy conducted and guarantees its removal out of the kidney together with the drainage on finishing therapeutic course and, also, it provides accurate application of light guide in carbuncular area and favors for rapid renal resolving process and normalization of patient's body state.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to urology, and can be used to treat kidney carbuncle in the early postoperative period.

In recent years, there has been a steady increase in the number of inflammatory diseases of the genitourinary system. An analysis of inflammatory diseases revealed a significant increase in the occurrence of kidney carbuncle. The incidence of apostematic pyelonephritis and kidney abscess for 10 years remains relatively stable, while the number of kidney carbuncles increases from year to year and increased by 4-5 times.

A known method of treating purulent pyelonephritis in the early postoperative period by drug therapy (Tiktinsky OL, Kalinina SN, "Pyelonephritis", Mediapress, St. Petersburg, 1996, 200-208).

However, the known method of treatment is not effective enough.

The closest to a positive result is a method for the treatment of purulent pyelonephritis in the postoperative period, which includes, along with drug-assisted laser intrapulmonary irradiation of the kidney, which consists in daily introduction through the nephrostomy drainage into the pelvis of the fiber with subsequent irradiation of the kidney (Urology and Nephrology, Moscow, Medicine, 1997, No. 6 pg. 14-17).

However, the known method of treatment is not effective enough, because a blindly inserted electrode irradiates different parts of the kidney surface each time without taking into account the localization of the carbuncle. In addition, daily introduction and removal of the fiber from the kidney can lead to displacement of nephrostomy drainage, impaired function, which can lead to the inability to continue laser irradiation.

The authors developed and proposed a highly effective method for the treatment of purulent pyelonephritis in the postoperative period, allowing irradiation directly in the focus of the main inflammation of the carbuncle.

A positive result of the claimed invention is to increase the effectiveness of treatment.

A positive result is achieved by the fact that in addition to complex antibacterial treatment, the patient is daily exposed to laser irradiation directly of the carbuncle zone through a light guide installed and fixed during the operation.

The method is as follows.

Under intubation anesthesia, in the corresponding lumbar region, a cut parallel to the costal arch cuts the skin, subcutaneous tissue, muscles, and excrete the kidney. An audit of the kidney is carried out, and after detection of the carbuncle zone, the latter is crosswise dissected to healthy kidney tissue. The renal pelvis is opened, nephrostomy drainage is established. Through its lumen, a fiber is inserted into the kidney, the end of which, under the control of the eye, is installed in the carbuncle zone and fixed to the nephrostomy drainage. Remove the renal capsule. A section of the pelvis of the kidney is sutured, layered seams on the wound. Nephrostomy drainage along with the light guide is fixed to the muscles and skin of the patient. The next day, an intrarenal therapy session with a helium-neon laser with a wavelength of 0.63 μm, a power of 40 mW / cm ² and a power of 2 mW at the end of the fiber, lasting 5 minutes, is carried out.

The use of laser irradiation directly of the carbuncle zone allows to increase the effectiveness of treatment, since Under the influence of laser therapy, cells are activated and proliferated, erythrocyte aggregation decreases, ATP levels increase, DNA synthesis is activated, leukocyte phagocytic activity increases, secretion of heparin, serotonin, histamine and other biologically active substances increases, microcirculation and oxygen utilization in tissues improve. All this contributes to the rapid resorption of the focus of the carbuncle and the restoration of normal renal tissue in this zone without irradiation of healthy areas of the kidney surface.

The clinical effect was observed after 5-6 sessions. It consisted in normalizing body temperature, the disappearance of chills, sweating, an increase in the amount of urine. On days 6-8, leukocyturia, bacteriuria decreased, and kidney function improved. On days 10-12, recovery came.

18 patients with a good clinical effect were treated. All patients recovered. At the same time, in the control group receiving conventional treatment in the postoperative period, its duration ranged from 18 to 22 days, 2 out of 15 patients developed bacteriotoxic shock, which ended in death, despite intensive therapy.

Clinical examples

1. The patient, 35 years old, was admitted to the urology department of the AKKB with a clinic of acute purulent pyelonephritis (pain in the lumbar regions more on the right, high body temperature, chills, nausea, vomiting). Upon admission, it was examined, changes were detected that indicated the presence of a carbuncle in the middle section of the right kidney. By ultrasound, the hypoechoic area of 3 × 2 cm in the middle segment of the right kidney. On the review and intravenous urograms: the contours of the kidneys are fuzzy, the function of the right kidney is reduced, deformation of the middle calyx of the right kidney is noted. In the general analysis of blood: l - 17.2 · 10 ⁹ / l, e - 0, p - 17, s - 69, l - 9, m - 5, ESR - 60 mm / h. In the general analysis of urine: protein - 0.33% o, l - a large number, bacteria ++.

Surgical treatment was performed according to urgent indications. When revising the right kidney in the middle segment, a section of a bluish-purple color 2 × 3 cm - a carbuncle was found. The carbuncle was dissected, the kidney was decapsulated, the fiber was inserted into the middle kidney cup, respectively, in the carbuncle zone, the fiber was removed through the nephrostomy drainage.

In the postoperative period, intensive antibacterial therapy was carried out (antibiotics, antispasmodics, vitamins, desensitizing drugs). It was supplemented by laser irradiation of the carbuncle zone for 5 minutes.

After a day, the patient's condition improved - body temperature decreased, pain decreased. After 3 days, body temperature returned to normal. No complaints of pain. In the general blood test, leukocytosis decreases, the stab shift is reduced. On the 6th day in the general blood test: l - 8.4 · 10 ⁹ / l, e - 2, s / I - 3, s / I - 68, l - 25, m - 2, ESR - 48 mm / h. During the control ultrasound, no signs of a hypoechoic area were found, blood flow in the carbuncle area was restored. Nephrostomy drainage along with the light guide was removed on the 10th day. On day 14, recovery came. The patient was discharged from the hospital.

2. Patient V., 24 years old, was admitted to the urology department of the AKKB with complaints of dull pain in the left lumbar region, chills, fever. Sick for a week. He became ill acutely after hypothermia. He was treated in the district hospital without effect, and therefore was transferred to our department. Upon receipt, the state of moderate severity. An objective examination noted pain in the left kidney. Complete blood count: l - 19.0 × 10 ⁹ / l, ESR - 48 mm / h, p / y - 28, s / i - 52, l - 15, m - 5, toxogenic neutrophil granularity ++, cytoplasm vacuolization neutrophils. OAM - specific weight 1010, protein 0.066% o, l - up to 25 in the field of view, bacteria ++. Ultrasound of the kidneys - in the left kidney, respectively, the lower segment is a hypoechoic area of 3 × 3 cm in size. According to the urogram, the outflow of urine from the left kidney is slowed down, deformation of the renal pelvis in the lower section. Diagnosed with carbuncle of the left kidney. According to urgent indications, the operation is an audit of the left kidney. During the operation, a lesion of a bluish-purple color 3 × 3.5 cm was discovered - a carbuncle. An excision of the carbuncle, decapsulation of the kidney, nephrostomy with the establishment of a fiber in the lower cup, respectively, of the carbuncle were performed. In the postoperative period, complex antibacterial therapy was carried out with daily laser irradiation of the carbuncle zone lasting 5 minutes. A total of 6 sessions. A week after the operation and the end of the course of laser therapy, the patient's condition improved, the pain disappeared, diuresis increased. The general blood count returned to normal. During the control ultrasound, no hypoechoic zones were found. Blood flow in the carbuncle area has recovered (according to Doppler ultrasound). On the 10th day, a nephrostomy with a light guide was removed. The recovery has come.

Thus, the use of laser irradiation of the kidney in complex postoperative therapy through a permanent light guide with an exact installation in the carbuncle focus helps to quickly resolve the process in the kidney and normalize the patient's condition.

Claims (1)

A method of treating a kidney carbuncle in the postoperative period by laser therapy, which involves the use of a helium-neon laser with a wavelength of 0.63 μm, a power of 40 mW / cm ² and 2 mW at the end of the fiber, characterized in that the laser fiber is installed directly in the carbuncle zone and fix to nephrostomy drainage during the operation, which, together with the light guide, is attached to the muscles and skin of the patient, laser irradiation is carried out daily for 5 minutes for 10 days.