To grasp the indications for the use of traditional Chinese medicine stone removal therapy The conditions for the use of stone removal therapy are: (1) the diameter of the stone is less than 1.0 centimeters, the shape is regular, the surface is smooth, and there is no adhesion with the pelvis calyx and free in the cavity; (2) there is no obvious deformity, stenosis, and infection of the urinary tract; (3) there is no serious hydronephrosis, the renal function is still good; (4) the young and strong physique, the body and mind of the patient are not in the best condition, but they can be used for the treatment of the disease, and they should be treated as the patients. 4) young adults with good physical fitness, can cooperate with a large amount of water and participate in physical activities favorable to lithotripsy. Only by fully understanding the conditions of the use of lithotripsy drugs, the patient can make the best self-selection of a variety of therapeutic means.
Taking stone removal drugs should pay attention to drink more water, hard activity During the drug should drink a lot of water, 2000 ~ 3000 ml per day, as far as possible to make the urine volume of 2000 ml per day or more. This can dilute the urine, reduce the precipitation of urinary salts, which is conducive to the discharge of stones. You should encourage yourself to jump and run more, and often do gymnastics, to encourage the stones to move and fall, in order to facilitate their own discharge.
Dietary taboos should not be ignored during the treatment period Dietary principles for patients with urinary stones tend to be low in animal protein, high in vitamins and vegetarian food. For stones combined with gout should limit meat, avoid eating animal offal, daily protein intake to no more than 90 grams is appropriate; less spinach, mushrooms, cauliflower, more fruits. The alkalization of urine is important in the prevention and treatment of uric acid stones, and it is advisable to choose alkaline vegetables and fruits to keep the pH value of urine within the range of 6.2 to 6.5.
High-calcium urinary stones with low-calcium foods as a preventive and therapeutic method can reduce morbidity and prevent recurrence. It has been reported that taking 10 to 24 grams of skimmed rice bran daily for 4 weeks to 2 months and limiting calcium intake to less than 700 milligrams per day can reduce calcium intake by utilizing phytic acid-containing phosphates in rice bran in combination with calcium.
The incidence of oxalate stones accounts for the vast majority of urolithiasis, which requires limiting the intake of foods high in oxalic acid, high in glycolic acid and high in calcium. Such as: spinach, potatoes, beets, asparagus, greens, squash, sherry, walnuts, hazelnuts, plums, strawberries, oranges, carrots, beans, celery, cucumbers, chocolate, strong tea (black tea), kelp, shrimp, scallops, sugar and so on is high oxalic acid food. Green grapes, limes, mushrooms, beets, walnuts, spinach, pears, tomatoes, and white potatoes are high ethanol acid foods. Milk powder is a high calcium food. There are many foods listed above that are not strictly contraindicated, but at the onset of the disease and during treatment, it is good to limit intake moderately.
The treatment of infected kidney stones has the following therapeutic prescriptions:
(1) tonifying the kidney stone walnut meat
Prescription: walnut 1000g, astragalus 60g, 30g of rockweed, 30g of chicken gold, Qianjian grass 250g, 250g of honey, 250g of sugar.
Preparation: ① walnuts shelled to take the meat, standby. ② fine salt or sand about 500g, poured into an iron pot. Salt first fried hot, and then poured into the walnut meat, to constantly stir-fry, until the walnut meat skin was tender yellow, about 10 minutes to stir-fry off the fire. After leaving the fire, also need to stir fry, to prevent burning; to be slightly cooled, with an iron sieve sieve to remove fine salt or sand; after cooling, and then take off part of the walnut coat, standby. (③) Quickly wash astragalus, stoneweed, jianneijin, and moneywort, pour them into a large casserole, and add cold water to submerge the medicines. Decoct for 40 to 60 minutes over medium heat, until the medicine thickens into a large bowl, strain out the head juice. Add 2 large bowls of water, until the medicine is decocted into a large bowl, filter out the second juice and discard the dregs. ④ first will be the juice, honey, sugar poured into a large porcelain pot, and then poured into the walnut meat, dip and mix evenly, porcelain pot with a lid, with a high fire steam 3 hours, away from the fire. Later, every two or three days to steam 1 time, each time about half an hour to steam, the more often the better.
Diet: 1 time a day, each time to drink 1 spoons of medicinal juice, eat 1 spoons of walnut meat, medicinal juice with warm water, walnut meat should be chewed until very fine before swallowing.
Effects: This formula nourishes the kidney and dissolves stones, supports the positive and dispels the evil, and strengthens the metabolic function of the urinary organs. It is especially suitable for people who have been sick and weak for a long time and those who are old and unable to expel stones, and it is also suitable for people who have suffered from kidney stones and ureteral stones for a long time.
(2) Sunflower Stem Heart Soup
Prescription: collect the inner core of sunflower stems, 50g of fresh or 20g of dried, 10g of talc, 1 spoon of honey.
Method: ① when the sunflower seed maturity, remove the seed disk, remove the underground root, take the stem, cut into sections, wash, cut open, take out the stem heart, chopped spare. ② sunflower stem heart and talcum poured into a small casserole, add cold water 1 big bowl and a half, decoction into half a bowl, filter out the juice, washed into 1 tbsp of honey.
Diet: Drink before meals, finish in 2 times or drink as tea.
Effects: This is the folk treatment of just suffering from urinary stones prescription, this formula through the diuretic, on the urinary tract stones and kidney stones have a better therapeutic effect, and no side effects. Especially suitable for the majority of rural patients, easy to take, simple to make. Drinking in summer, there is also the function of removing summer heat.
(3) Hai Jinsha tea
Prescription: Hai Jinsha 15g, green tea 2g, to the best of the old.
Method: sea gold sand each 10 to 15g, green tea 2 to 3g, the two into a cup, with just boiling water to brew most of the cup, immediately after the bubble cover, 5 minutes after drinking.
Eating method: daily morning, empty stomach first drink a cup, and then can be drunk at any time. Each drink slightly left the remaining juice, and then bubble and drink again, until diluted. 2 months for a course of treatment.
Effects: This formula has the effect of clearing heat and dampness, diuretic and detoxification, reducing fire and detoxification, etc. It has the effect of preventing and controlling kidney stones and bladder stones, and it is suitable for those who are suffering from dampness-heat syndrome with yellow and greasy tongue coating, yellow and red color of urine, unsmooth urination, and hot and painful urination.
★Kidney stones are definitely not okay if left untreated, as they will continue to accumulate and grow, and if they are not eliminated in a timely manner, then there is only one way to go, surgery.
Urinary stones
Urinary stones are one of the most common urological diseases. Men outnumber women by about 3:1. In the last 30 years, the incidence of upper urinary tract (kidney, ureter) stones has increased significantly in China.
Overview of urinary tract stones
Urinary tract stones are one of the most common urologic diseases. Males outnumber females by about 3:1. In the last 30 years, the incidence of upper urinary tract (kidney, ureter) stones has increased significantly in China.
Urinary stone etiology
The mechanism of stone formation has not been fully elucidated, and it is thought to be related to metabolic and infectious factors.
Urinary stone symptoms
The main symptoms are pain and hematuria, and a very small number of patients can be asymptomatic for a long time.
(A) Pain: Most patients present with low back pain or abdominal pain. Larger stones, mostly for the affected side of the lumbar region of the dull pain or hidden pain, often in the activities after the aggravation; smaller stones, mostly caused by smooth muscle spasm and colic, this colic is often a sudden occurrence, the pain is intense, such as cut-like, radiating to the lower abdomen, vulva and inner thighs. Sometimes the patient is accompanied by pallor, cold sweat, nausea, vomiting, and in severe cases, the pulse is weak and fast, and the blood pressure drops. The pain often comes in paroxysms, or can be suddenly terminated or relieved by a certain action, leaving hidden pain in the waist and abdomen.
(2) Hematuria: Because the stone directly damages the mucous membrane of kidney and ureter, microscopic hematuria or microscopic hematuria often occurs after severe pain, and the severity of hematuria is related to the degree of damage.
(3) Pyuria: pus cells appear in the urine when kidney and ureteral stones are complicated by infection, and high fever and lumbar pain can be clinically seen.
(4) other: stone obstruction can cause hydronephrosis, renal insufficiency, some patients may also appear gastrointestinal symptoms, anemia and so on.
Urinary stone examination
(A) laboratory tests: routine urine examination can be seen red blood cells, white blood cells or crystals, urine pH in patients with oxalate and urate stones are often acidic; phosphate stones are often alkaline. Combined with infection, more pus cells appear in the urine, and when the infection is more serious, the total number of leukocytes and neutrophils can be seen in routine blood tests are elevated.
(2) X-ray examination: X-ray examination is an important method of diagnosis of kidney and ureteral stones, about 95% of the urinary tract stones can be visualized on X-ray flat film. Supplemented with excretory or retrograde pyeloureterography , it can determine the location of the stone, the presence of obstruction and the degree of obstruction, the opposite side of the renal function is good or not, to distinguish the shadow of calcification from outside the urinary tract, to exclude the upper urinary tract of other pathologies, to determine the treatment plan and the location of the stone, size and number of the comparison of the post-treatment stones have an important value.
(3) other tests: ultrasound can detect dense light spots or light clusters in the stone site, and can detect liquid flat segments when combined with hydronephrosis. The isotope nephrography can be seen on the affected side of the urethra in an obstructive pattern.CT scanning is not as intuitive as X-ray and urography, and the cost is expensive, it is generally not a routine examination.
Urinary stone treatment
The treatment of renal and ureteral stones should be based on the size, location, number, shape, one side or both sides of the stone, with or without urinary flow obstruction, associated infections, the degree of renal impairment, the systemic condition, and the conditions of the treatment to be analyzed in specific terms and considered comprehensively. However, when colic attacks, the symptoms should be relieved first, and then choose the treatment plan.
(I) Management of renal colic.
1. Antispasmodic pain relief:
2. Acupressure pain relief:
3. Local closure of skin sensitized areas:
4. Acupuncture therapy:
(ii) Non-surgical treatment.
Non-surgical therapy is generally suitable for stone diameter of less than 1 centimeter, smooth periphery, no obvious urinary obstruction and infection, for some clinically non-symptomatic intra-renal larger deuterostomal stones, can also be temporarily non-surgical treatment.
1. Drink a lot of water: increase the volume of urine to flush the urinary tract, promote the downward movement of stones, dilute the urine to reduce crystal precipitation.
2. Herbal treatment:
3. Acupuncture method: increase the peristalsis of the renal pelvis and ureter, which is conducive to the discharge of stones.
4. Frequent jumping activities, or inverted position and tapping activities for stones in the renal calyx are also conducive to the discharge of stones.
5. Other: for those who have bacterial infection in urine culture, use sensitive drugs (Ophtham, Mirex) to actively fight infection, and for those who have metabolic disorders in the body, they should actively treat the primary disease and regulate the acidity and alkalinity of the urine, and so on.
(3) Extracorporeal shock wave lithotripsy.
(4) Surgical treatment.
Surgical treatment should be considered if the stone causes obstruction of urinary flow that has affected renal function, or if the non-surgical treatment is ineffective and there is no condition for extracorporeal shock wave lithotripsy.
Preoperative preparation: preoperative renal function must be known bilaterally, and those with infection should first use antibacterial agents to control the infection. Ureteral stone patients before entering the operating room or on the operating table preoperative urethrogram for the final localization of the stone.
Surgical methods: According to the size, shape and location of the stone, the following surgical methods are commonly used:
1. renal pelvis or renal sinus incision lithotripsy: incision of the renal pelvis, to remove the stone, staghorn stone or calyceal stone, and sometimes have to be made in the renal sinus of the pelvis calyceal incision lithotripsy.
2. Parenchyma incision lithotripsy: renal stones are large and cannot be removed by renal sinus incision, the renal parenchyma needs to be incised to remove the stone.
3. Partial nephrectomy: for multiple stones in the pole of the kidney (mostly in the lower pole of the kidney), or located in the dilated calyx with poor drainage, the pole or calyx of the kidney can be removed together with the stones.
4. Nephrectomy: one side of the kidney stones and serious hydronephrosis or pus, has made the renal function seriously impaired or loss of function, while the opposite side of the kidney function is good, feasible to remove the affected kidney.
5. Ureteral lithotomy: ureteral stone diameter greater than 1 centimeter or stone embedded caused by urinary obstruction or infection, the non-surgical treatment is ineffective ureteral lithotomy.
6. stone set: ureteral stones in the lower part of the diameter of less than 0.6 centimeters, can be tried through the cystoscopy with a special set of basket or catheter set
Ureteral stones more than 90% of the formation of the kidneys and descending into the ureter, unless there is a ureteral obstruction lesions, the primary ureteral stone is rare. The etiology of ureteral stones is the same as that of renal stones, but after entering the ureter, the stones gradually become date-nut shaped. According to national statistics, about 70% of ureteral stones are located in the pelvis at the time of treatment, 15% are located in the middle 1/3 of the ureter, and the least in the upper l/3. Due to the peristalsis of the ureter and the fast flow of urine in the tube, small stones with a diameter of less than 0.4 centimeters are more likely to descend automatically into the bladder and be excreted with the urine.
Ureteral stones are more common in men than in women, with the highest incidence in the 20-40 age group. Its clinical symptoms are basically the same as those of kidney stones. Upper and middle ureteral stones causing ureteral colic are characterized by lumbar pain on one side and microscopic hematuria. The pain may radiate to the lower abdomen testis or labia. Hematuria is usually mild, with most having only microscopic hematuria, but it can worsen after an episode of pain and occurs in about half of patients with hematuria of the naked eye. Nausea and vomiting are also common symptoms. Stones in the bladder wall segment of the ureter can cause urinary urgency, frequency, and pain, which may be related to the fact that the muscles of the lower end of the ureter are connected to the muscles of the deltoid region and are directly attached to the posterior urethra. Because of the small lumen of the ureter, it is easy to cause obstruction, causing ipsilateral hydronephrosis and infection. In the presence of hydronephrosis and infection, the kidney may be palpable on physical examination with tenderness, sometimes along the ureteral tract. Rectal palpation may reveal stones in the lower end of the ureter.
An attack of colic on one side and a small number of red blood cells in the urine under the microscope is an important clue to the detection of ureteral stones. more than 90% of ureteral stones can be visualized on X-ray. ultrasound can detect hydronephrosis. Occasionally, ureteral stones are seen only when hydronephrosis is detected. Intravenous urography is the most helpful in diagnosis, as it provides information about the location of the stone, the degree of renal damage and obstruction, and the function of the contralateral kidney. If the conventional dose is poorly visualized, the use of high-dose contrast can often determine the function of the affected kidney, which is valuable in the choice of treatment. Combination of Chinese and Western medicine to treat smaller ureteral stones has achieved good results in China, and most stones with a diameter of less than 0.4 centimeters or up to 1.0 centimeters individually may be discharged by using a combination of Chinese and Western medicine. The advantage of this method is easy to promote, the disadvantage is that patients need to tolerate the pain of stone removal. After 4 weeks of usual medication, 70% of smaller ureteral stones may be discharged. In recent years, percutaneous lithotripsy and ureteroscopic lithotripsy have been used, and ultrasound can also be used to crush the stones in the lower ureter, which can be crushed directly under direct vision with a special probe. Extracorporeal shock wave lithotripsy is accepted for its efficacy and low pain. Regardless of the method of stone removal or extraction, it is symptomatic treatment. For stones that have the possibility of recurrence, it is necessary to carry out various etiologic examinations to remove the cause of the disease, or correctly apply medication to prevent the recurrence of stones.
Kidney and ureteral stone patients, after treatment, should be appropriate to increase the amount of exercise and drinking water, especially often drink the Chinese medicine Qiancheng brewed water (instead of tea), to help prevent the recurrence of stones.
Therapeutic principles
1. Non-surgical treatment: applicable to patients with stones less than lcm, stone position with a tendency to move downward, no obvious effect on renal function, and no urinary tract infection. Drink a lot of water, take traditional Chinese medicine, the application of antispasmodic agents, jumping activities and so on.
2. Ureteral set stone: in the bladder dirty mirror with set stone basket to pull out the stone. It is suitable for small active lower and middle ureteral stones.
3. Ureteroscopic lithotripsy or lithotripsy: ureter dilatation after the ureter into the ureteroscope, see the stone with liquid electric or ultrasonic lithotripsy broken, the stone can also be directly removed with a lithotripsy forceps.
4. Extracorporeal impulse wave lithotripsy: mainly for the upper ureteral stone.
5. Surgical ureterotomy: it is suitable for the patients who are not effective in the above therapies, whose stones are larger than lcm, and whose surface is rough and cannot be discharged by themselves, or who have ureteral stenosis and infection.
Prevention:
Diet
①Daily water intake of 2000-3000 ml, increased to 4000-5000 ml in hot summer, and increased after sweating, to maintain at least 2000 ml of urine daily.
②Magnetized water can be used to drink, the water is easy to disintegrate the stone.
③Eat more food containing vitamin A, such as pig liver, eggs, and fresh cabbage and fruits.
4 Less calcium-rich foods such as kelp, black fungus, beans, amaranth, milk, celery, nori, moray eel, salted radish, pumpkin seeds, dried red dates and so on.
⑤ Eat less oxalic acid-rich foods, such as spinach, celery, cocoa, coffee, beets, grass mold, oranges, white potatoes, black tea and so on.
6 Eat less food that tends to cause an increase in urate, cystine, and xanthine, such as animal offal, seafood, bean curd, and peanuts.
There are many factors that cause kidney stones, such as metabolic disorders, hyperparathyroidism, urinary tract infections, obstruction or chemical factors and many other unknown causes. Stones according to the main crystal components contained, divided into oxalate stones, phosphate stones, urate stones, calcium salt, cystine stones and so on. According to incomplete statistics in China, the composition of stones varies from region to region, and oxalate and phosphate stones are generally more common. Therefore, the diet should be controlled according to the nature of the stones.
Oxalate stones: most of them are generated from food, and some of them can also be generated by endogenous mechanisms. Diet should abstain from oxalate-containing vegetables, such as spinach, amaranth, water spinach, green garlic, onions, wild rice, and all kinds of bamboo shoots. Oral folic acid 5 mg and pyridoxine 10 mg can prevent the conversion of glycine to oxalic acid. Patients suffering from such stones should drink more water.
Phosphate stones: due to the formation of alkaline urine, so we should eat more acidic food, while limiting the high calcium-containing foods. Become acidic foods such as livestock and poultry meat, fish and shrimp, eggs, cereals peanuts and so on.
Urate stones: is caused by hyperuricemia, so it should be prohibited to eat high purine-containing foods, such as animal offal, thick broth, mushrooms, peas, lobster, sardines, anchovies, fish roe and so on. You should eat more vegetables and fruits and drink more water to reduce uric acid concentration.
Calcium salt stones: it is advisable to limit the calcium-containing milk, cheese, shrimp, etc.. You should eat more acid-forming foods, such as meat, poultry and eggs, to make the urine acidic and drink a lot of water.
Cystine stones: it is important to limit methionine and acidic foods (animal foods) and eat more alkaline foods (plant foods) to make the urine alkaline and drink a lot of water.
There are many treatment methods for kidney stones, which need to be selected by the hospital according to the specific location and size of the stone, such as drug lithotripsy, lithotriptic machine lithotripsy, surgery and so on can achieve the purpose of radical treatment
(A) prevention and treatment of stone formation and recurrence
1. Remove the causes of the onset of kidney stones and actively treat the causes of stone formation, such as primary hyperparathyroidism, removal of parathyroid, treatment of malignant disease. Removal of parathyroid glands in primary hyperparathyroidism, treatment of malignant tumors, control of renal pelvic infection and relief of urinary tract obstruction are effective measures to prevent stone formation and recurrence.
2. General treatment
(1) Ensure adequate water intake: it is best to drink magnetized water containing less minerals so that the daily urine volume is more than 2000 ml, which can dilute the urine, reduce the precipitation of crystals, flush the urinary tract and discharge tiny stones.
(2) Diet: Dietary composition should be based on the type of stone and urine pH. For calcium oxalate stones, foods high in oxalic acid such as spinach, tomatoes, potatoes, beets, lobelia, nuts, tea, cocoa and chocolate should be avoided. As well as foods high in calcium such as milk and cheese. For idiopathic hypercalciuria, calcium intake should be restricted to reduce urinary calcium levels; for recurrent oxalate stones that are not hypercalciuric, a low-calcium diet is not necessary. If stones are formed due to increased urinary oxalate excretion caused by a low-calcium diet, a low-calcium diet should not be used. Control sodium intake, excessive sodium intake can increase urinary calcium excretion. Hyperuricemia and hyperuricosuria to eat purine diet, avoid eating animal offal, eat less fish and coffee.
3. Drug therapy
(1) hypercalciuria: caused by primary hyperparathyroidism, sarcoidosis, hyperthyroidism, multiple myeloma, etc. should be treated accordingly. Other causes can take the following measures
1) thiazide diuretics: dihydroclonidine 50-100mg per day, or the corresponding dose of other diuretics.
2) sodium phosphate fiber resin: each time 2.5 ~ 5g, eat and take at the same time. At the same time should be appropriate to limit the intake of oxalic acid, while supplemental calcium.
3) orthophosphate: 1.5 to 2.0g of elemental phosphorus per day, divided into 3 to 4 times. Glomerular filtration rate of less than 30ml/min and urinary tract infections do not use, because it can cause metastatic soft tissue calcification and infected stones.
(2) Intestinal hyperoxaluria: magnesium hydroxide or magnesium oxide can be used. Anticholinergic amines can correct intestinal malabsorption of fat, but cannot continuously inhibit the absorption of oxalic acid.
(3) Low urine citrate calcium-containing kidney stones: the usage is 3 to 6g per day, divided into three times. Some patients may have mild gastrointestinal reactions, and it is used with caution in renal insufficiency.
(4) uric acid stones: potassium citrate clinically preferred, the dose of 30 to 60 mmol / d. If at the same time there is increased blood uric acid, it is appropriate to add the allopurinol, control blood uric acid concentration that is changed to a maintenance dose.
(5) Cystinuria and cystine stones: when the treatment is ineffective in ensuring adequate water intake (often >3L/d) and alkalinization of urine (pH>7.5), D-penicillamine can be applied to treat the problem, 1-2g per day, in divided doses. α-mercaptopropyleneglycine has a similar mechanism of action as D-penicillamine, with fewer side effects.
(6) Infected stones: long-term effective control of urinary tract infections can limit the formation of infected stones, and even make some of the formed stones dissolved. However, due to the low concentration of antibiotics in the stone, the bacteria can not be completely killed, so pure antibacterial treatment is difficult to make a complete cure for urinary tract infections
(2) Treatment of stones
The treatment of renal stones has made great progress in recent years, and many of the renal stones that required surgical treatment in the past can now be extracted by extracorporeal shockwave lithotripsy or non-open surgical removal of the stone or a combination of several methods to achieve a The results are satisfactory. <BR><BR> Internal medicine treatment for smooth round stones with a diameter of less than 0.5mm, without urinary tract obstruction or infection, and with good renal function, can be used for internal medicine treatment. Litholytic therapy is more effective for uric acid stones and cystine stones, and less effective for calcium-containing stones and infected stones, and is administered orally, intravenously, by ureteral cannula, open nephrostomy cannula, and percutaneous nephrolithotomy cannula. During the treatment period, should be closely observed changes in the condition, regular radionuclide nephrogram and X-ray examination to understand the renal function, to determine whether the operation
(C) symptomatic treatment
1. renal colic treatment application of antispasmodic agent atropine or 654-2 intramuscular injection can be combined with ipecac to enhance the effectiveness of the ineffectiveness of the application of dulcolax or morphine, etc..
2. For the treatment of urinary tract infections, see "Urinary tract infections".
3. When hematuria is obvious and the naked eye hematuria, hydroxybenzylamine 0.1-0.2g or hemostatic cyclic acid 0.1g can be injected intravenously three times a day slowly.