METHOD OF SURGICAL MINIMALLY INVASIVE TREATMENT OF NEPHROLITHIASIS IN ADULTS

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, specifically to urology. Simultaneously two kidney accesses are performed. Access to the renal cavity is ensured by ultrasound and X-ray guidance by puncture with calyxal needle located in avascular zone of Bradle and coinciding in direction with location of main volume of stone. Further, along the needle, a cord-guide and a second renal puncture through a calyx located in the direction of the stone from the first approach. Thereafter, a guide wire is inserted along the needle into the renal cavity system and the bougienage is performed for the basic access using a telescopic set with an external tube installation of standard nephroscope 24 Charrier and performing one-stage additional access bougienage with mini-nephroscope 16.5 Charrier. Further, through created accesses, kidney stones are removed by making contact lithotripsy by main approach with an ultrasonic probe with simultaneous lapaxia of small fragments and conduction of contact holmium laser lithotripsy along the additional mini access with instrumental movement of concrements into the working area of the standard nephroscope, and stone fragments, comparable in diameter to the tube, are extracted to the outside with a lithoextractor. After complete removal of stones, endoscopic inspection is performed under X-ray control. Thereafter, the mini-nephroscope tube is removed to leave an insurance guide string in place of its standing to monitor haemorrhage from access and in the absence of that, draining is carried out along the main percutaneous passage with the help of balloon nephrostome 18 Charrier with filling cylinder by 3 ml. Further, under X-ray control, adequacy of drainage standing is determined by performing antegrade pyeloureterography, operation is completed by closing skin incision with temporary installation of balloon nephrostomy drainage along percutaneous tract, fixing it to skin incision with separate interrupted suture.;EFFECT: method enables considerably reducing the length of operation, on average by 40 %, allowing to extract fragments of the concrement from hard-to-reach parts of the pelvis-pelvis system without additional damage to the intrarenal structures, thereby reducing the probability of hemorrhagic and infectious-inflammatory complications twice as compared to the standard approach.;1 cl, 1 ex, 7 dwg