Grasping the indications of Chinese medicine stone-removing therapy, the conditions for applying stone-removing therapy are as follows: (65,438+0) The stone diameter is less than 65,438+0.0 cm, the shape is regular, the surface is smooth, and there is no renal pelvis and calyx; (2) The urinary tract has no obvious deformity, stricture and infection; (3) No severe hydronephrosis and good renal function; (4) Young and middle-aged people are healthy, so they can drink plenty of water and participate in sports activities that are conducive to stone removal. Only when patients fully understand the conditions of using calculus-removing drugs can they make the best self-choice for various treatment methods.
You can choose Shiyushu tea to take calculus-expelling drugs. You should pay attention to drink plenty of water, and drink plenty of water during taking the medicine, 2000 ~ 3000 ml per day, and try to make the urine volume reach more than 2000 ml per day. This can dilute urine, reduce urinary salt precipitation, and is conducive to the discharge of stones. Encourage yourself to jump and run more, and often do gymnastics to make stones move and fall, which is convenient for self-discharge.
During the treatment, diet can not be ignored. The dietary principle of patients with urinary calculi tends to be vegetarian with low animal protein and high vitamins. For patients with stones complicated with gout, meat should be restricted and animal viscera should not be eaten. The daily intake of protein should not exceed 90g. Eat less spinach, mushrooms, cauliflower and more fruits. Urine alkalization is of great significance in the prevention and treatment of uric acid stones. It is advisable to eat alkaline vegetables and fruits to keep the PH value of urine in the range of 6.2 ~ 6.5.
Using low-calcium food as a prevention and treatment method of high-calcium urinary calculi can reduce the incidence and prevent recurrence. It has been reported that taking 10 ~ 24g defatted rice bran every day for 4 weeks ~ 2 months, and limiting calcium intake to 700 mg per day, can combine phytic acid-containing phosphate in rice bran with calcium and reduce calcium intake.
The incidence of oxalate stones accounts for the vast majority of urolithiasis, so it is required to limit the intake of foods with high oxalic acid, high glycolic acid and high calcium. For example, spinach, potato, beet, asparagus, rape, mustard tuber, sherbet, walnut, hazelnut, plum, strawberry, orange, carrot, bean, celery, cucumber, chocolate, strong tea (black tea), kelp, shrimp skin, hairtail and sugar are all high oxalic acid foods. Green grapes, limes, mushrooms, beets, walnuts, spinach, pears, tomatoes and sweet potatoes are all high glycolic acid foods. Milk powder is a high calcium food. There are many foods listed above, which are not strictly taboo, but it is better to limit the intake moderately during the onset and treatment.
There are the following therapeutic prescriptions for treating infectious kidney calculi:
(1) Kidney-tonifying fossil walnut kernel
Prescription: walnut1000g, astragalus 60g, pyrrosia 30g, Endothelium Corneum Gigeriae Galli 30g, Lysimachia christinae 250g, honey 250g and sugar 250g.
Methods: ① Walnut was shelled and meat was taken for later use. ② Pour about 500g of fine salt or sand into the iron pot. Stir-fry the salt first, then pour in the walnuts. Stir-fry until the walnut skin is tender and yellow, and stir-fry until 10 minute. Stir-fry after leaving the fire to prevent burning; After cooling slightly, remove fine salt or sand with an iron sieve; After cooling, remove a part of walnut skin for later use. ③ Quickly wash Radix Astragali, Folium Pyrrosiae, Endothelium Corneum Gigeriae Galli and Herba Lysimachiae Christinae, pour into a large casserole, and add cold water to soak the medicine. Decoct for 40-60 minutes on medium fire until the liquid medicine is concentrated to half a bowl, and filter out the juice. Add 2 bowls of water until the liquid medicine is decocted to more than half a bowl, filter out two juices and discard the residue. (4) Pour the medicinal juice, honey and sugar into a large porcelain basin, then pour the walnut kernel, soak and stir evenly, cover the porcelain basin, steam for 3 hours on high fire, and then leave the fire. After that, steam 1 time every two or three days, about half an hour each time, and the more times, the better.
How to eat: once a day, drink 1 spoon of medicinal juice and eat 1 spoon of walnut kernel. The medicine juice should be taken with warm water, and the walnut kernel should be chewed carefully before swallowing.
Efficacy: This prescription can tonify kidney fossils, strengthen the body resistance and eliminate pathogens, and enhance the metabolic function of urinary organs. It is especially suitable for the infirm, the elderly and the infirm who have been ill for a long time, and also suitable for those who have suffered from kidney calculi and ureteral calculi for a long time.
(2) Sunflower Stewed Heart Decoction
Prescription: Take sunflower stem core, fresh 50g or dried 20g, talc 10g, honey 1 spoon.
Methods: ① After the sunflower seeds are ripe, take out the seed tray, remove the underground roots, take the stem, cut it into several sections, wash it, cut it open, take out the stem core and chop it for later use. ② Pour sunflower stems and talc into a small casserole, add 1 large bowl of half cold water, fry until half a bowl, filter out the juice, and pour 1 spoonful of honey.
How to eat: Take it before meals, and drink it twice or regularly instead of tea.
Efficacy: This is a folk prescription for treating urinary calculi. This prescription has a good therapeutic effect on urinary calculi and kidney calculi, and has no side effects. Is especially suitable for rural patients, and has the advantages of convenient material acquisition and simple manufacture. Drinking clothes in summer also has the effect of dispelling summer heat.
(3) Lygodium japonicum tea
Prescription: 15g Lygodium japonicum, 2g green tea, aged best.
Methods: Lygodium japonicum 10 ~ 15g, green tea 2 ~ 3g each time, put into a cup, brew half a cup with boiling water, cover it immediately after soaking, and take it 5 minutes later.
How to eat: drink a cup on an empty stomach every morning, and then take it at any time. Leave a little juice after each drink, and then soak it until it is diluted. Two months is 1 course of treatment.
Efficacy: This prescription has the effects of clearing away heat and infiltrating dampness, inducing diuresis to treat stranguria, reducing fire and detoxifying, and has preventive and therapeutic effects on kidney calculi and bladder stones. It is suitable for damp-heat syndrome, yellow greasy tongue coating, Huang Chi urine color, and unfavorable urination.
★ If kidney calculi is not treated, it will definitely not work, because stones will continue to accumulate and grow. If we don't destroy them in time, there is only one way to go.
lithangiuria
Urinary calculi are one of the most common urinary system diseases. There are more men than women, about 3∶ 1. In recent 30 years, the incidence of upper urinary calculi (kidney and ureter) in China has increased significantly.
Overview of urinary calculi
Urinary calculi are one of the most common urinary system diseases. There are more men than women, about 3∶ 1. In recent 30 years, the incidence of upper urinary calculi (kidney and ureter) in China has increased significantly.
Etiology of urinary calculi
The mechanism of stone formation has not been fully clarified, and it is mostly considered to be related to metabolism and infection factors.
Symptoms of urinary calculi
The main symptoms are pain and hematuria, and very few patients can be in a coma for a long time.
(1) Pain: Most patients have low back pain or abdominal pain. Larger stones are mostly dull or dull pain in the affected side of the waist, which is often aggravated after exercise; Smaller stones often cause smooth muscle spasm and colic, which often occur suddenly and have severe pain, such as knife cutting, radiating to the lower abdomen, vulva and inner thigh. Sometimes patients are accompanied by pale face, cold sweat, nausea and vomiting, and in severe cases, symptoms such as weak and fast pulse and decreased blood pressure appear. Pain is often paroxysmal, but also can be suddenly terminated or relieved by a certain action, leaving a dull pain in the waist and abdomen.
(2) Hematuria: Because stones directly damage the mucosa of kidney and ureter, microscopic hematuria or gross hematuria often occurs after severe pain, and the severity of hematuria is related to the degree of injury.
(3) pyuria: pyogenic cells appear in urine when renal and ureteral stones are complicated with infection, and high fever and low back pain may appear clinically.
(4) Others: Stone obstruction can cause hydronephrosis and renal insufficiency, and some patients may also have gastrointestinal symptoms and anemia.
Urinary calculi examination
(1) Laboratory examination: Routine urine examination can show red blood cells, white blood cells or crystals, and the urine pH value of patients with oxalate stones and urate stones is often acidic; Phosphate stones are usually alkaline. There are more pus cells in urine when complicated with infection. When the infection is serious, routine blood examination can increase the total number of white blood cells and neutrophils.
(2) X-ray examination: X-ray examination is an important method to diagnose renal and ureteral stones, and more than 95% of urinary calculi can be developed on X-ray plain films. Combined with excretory or retrograde pyeloureterography, it is of great value to determine the location of stones, whether there is obstruction or not, whether the contralateral renal function is good, distinguish the shadow of urinary calcification, exclude other lesions of upper urinary tract, determine the treatment plan, and compare the location, size and number of stones after treatment.
(3) Other examinations: B-ultrasound can find dense light spots or light masses at the stone site, and can detect the liquid level when hydronephrosis occurs. Isotopic renogram showed that the affected urinary tract was obstructed. CT scan is not as intuitive as X-ray plain film and urography, and it is expensive, so routine examination is generally not done.
Treatment of urinary calculi
The treatment of renal and ureteral calculi should be based on the size, location, quantity, shape, one side or both sides, whether there is urinary tract obstruction, whether there is infection, the degree of renal function damage, general situation and treatment conditions. However, when colic attacks, the symptoms should be relieved first, and then the treatment scheme should be selected.
(1) Treatment of renal colic.
1. Spasm and pain relief:
2. Acupoint massage to relieve pain:
3. Local sealing of skin allergic area:
4. Acupuncture therapy:
(2) Non-surgical therapy.
Non-surgical treatment is generally suitable for patients with stone diameter less than 1 cm, smooth periphery and no obvious urinary tract obstruction. Temporary non-surgical treatment can also be given to some large staghorn stones in the kidney that do not cause symptoms clinically.
1. Drink plenty of water: increase urine volume to flush the urinary tract, promote the downward movement of stones, and dilute urine to reduce crystal precipitation.
2. Chinese herbal medicine treatment:
3. Acupuncture: increase the peristalsis of renal pelvis and ureter, which is beneficial to the discharge of stones.
4. Frequent jumping activities, or handstanding and patting the stones in the renal calices are also beneficial to the discharge of stones.
5. Others: For those infected with bacteria in urine culture, sensitive drugs (nitrofurazone and metronidazole) should be used to actively fight infection; For patients with metabolic disorder in the body, the primary disease should be actively treated and the pH value of urine should be adjusted.
(3) extracorporeal shock wave lithotripsy.
(4) Surgical treatment.
If urinary tract obstruction caused by stones has affected renal function, or non-surgical treatment is ineffective, and extracorporeal shock wave lithotripsy is not available, surgical treatment should be considered.
Preoperative preparation: We must know the bilateral renal function before operation and control infection with antibiotics. Patients with ureteral calculi should take a plain film of urinary tract before entering the operating room or before operating on the operating table to determine the final position of the calculi.
Surgical methods: According to the size, shape and location of stones, the following surgical methods are commonly used:
1. Incision of renal pelvis or renal sinus to remove stones, staghorn stones or renal calices stones, and sometimes incision of renal pelvis and renal sinuses to remove stones.
2. Nephrolithotomy: If the kidney calculi is too big to be cut through the renal sinus, the renal parenchyma should be cut for lithotomy.
3. Partial nephrectomy: It is suitable for multiple kidney calculi (mostly located in the lower pole of the kidney), or located in the dilated renal calices with poor drainage. One pole or calyx of the kidney can be removed together with the stone.
4. Nephrectomy: One side of kidney calculi has serious hydronephrosis or pyonephrosis, which has been seriously damaged or lost its function, and the other side has good renal function, so it is feasible to remove the affected kidney.
5. Ureterotomy: Ureterolithotomy is feasible if ureteral stones with a diameter greater than 1cm or stone incarceration cause urinary tract obstruction or infection, and non-surgical treatment is ineffective.
6. Lithotripsy: The diameter of the stones in the middle and lower ureter is less than 0.6 cm, and the stones can be removed by cystoscope with special basket or catheter.
More than 90% of ureteral calculi are formed in the kidney and fall into the ureter. Primary ureteral calculi are rare unless there is ureteral obstruction. The etiology of ureteral calculi is the same as that of kidney calculi, but after the stones enter the ureter, they gradually become jujube stones. According to domestic statistics, about 70% of ureteral calculi are located in pelvic cavity, 15% in ureter and 1/3, and the upper l/3 is the least. Due to the peristalsis of the ureter and the rapid flow of urine in the tube, small stones with a diameter less than 0.4 cm are more likely to automatically fall into the bladder and be discharged with urine.
Ureteral calculi are more common in men than in women, and the incidence rate is the highest in 20-40 years old. Its clinical symptoms are basically the same as those in kidney calculi. Ureteral colic caused by upper and middle ureteral calculi is characterized by unilateral low back pain and microscopic hematuria. Pain can radiate to the testicles or labia in the lower abdomen. Hematuria is generally mild, and most of them only have microscopic hematuria, but it can be aggravated after the onset of pain. About half of the patients have gross hematuria. Nausea and vomiting are also common symptoms. Calculi in ureter and bladder wall can cause urgency, frequent urination and painful urination, which may be related to the connection between the lower ureter muscle and the triangle muscle, and directly attached to the posterior urethra. Because the ureter lumen is small, it is easy to cause obstruction, causing ipsilateral hydronephrosis and infection. If there is hydronephrosis and infection, the physical examination can touch the kidney and have tenderness, sometimes along the ureter. Digital rectal examination can touch the lower ureteral calculi.
Unilateral colic attack and a small amount of red blood cells in urine under microscope are important clues to find ureteral calculi. During X-ray examination, more than 90% ureteral stones can be developed on X-ray films. Hydronephrosis can be found by B-ultrasound. Occasionally, ureteral calculi are treated because hydronephrosis is found. Intravenous urography is the most helpful for diagnosis, which can know the location of stones, the degree of renal function damage and obstruction, and the function of the contralateral kidney. If the effect of conventional dose imaging is not good, the function of the affected kidney can often be determined by using a large dose of contrast agent, which is of certain value to the choice of treatment methods. The treatment of small ureteral calculi with integrated traditional Chinese and western medicine has achieved good results in China. Most stones with a diameter less than 0.4 cm or individual stones as high as 1.0cm may be discharged after treatment with integrated traditional Chinese and western medicine. The advantage of this method is that it is easy to popularize, but the disadvantage is that patients have to endure the pain of taking stones. After 4 weeks, 70% of the smaller ureteral stones may be discharged. In recent years, percutaneous nephrolithotomy and ureteroscopy have been adopted, and stones in the lower ureter can also be crushed by ultrasound. Calculi in the lower ureter can be directly crushed with a special probe under direct vision. Extracorporeal shock wave lithotripsy is accepted by people because of its good curative effect and little pain. No matter what method is used to remove stones or stones, it is symptomatic treatment. For stones with the possibility of recurrence, it is necessary to carry out various etiological examinations, eliminate the causes, or correctly apply drug treatment to prevent the recurrence of stones.
After treatment, patients with renal and ureteral calculi should appropriately increase the amount of exercise and drinking water, especially drinking the water brewed by Chinese medicine Lysimachia christinae (instead of tea) frequently, which is helpful to prevent the recurrence of stones.
Principles of treatment
1. Non-surgical treatment: it is suitable for patients whose stones are smaller than lcm, with a downward trend, no obvious influence on renal function and no urinary tract infection. Drink more water, take traditional Chinese medicine, use antispasmodic, jump and so on.
2. Ureteral stone sleeve: Take out the stone with a stone sleeve basket under the endoscope. It is suitable for small active middle and lower ureteral calculi.
3. Lithotripsy or lithotripsy under ureteroscope: After ureterectasis, put it into ureteroscope, and crush the stones with a hydraulic or ultrasonic lithotriptor, or take out the stones directly with a lithotomy forceps.
4. Extracorporeal shock wave lithotripsy: mainly suitable for upper ureteral calculi.
5. Surgical ureterolithotomy: It is suitable for patients who are ineffective in the above treatment, whose stones are larger than lcm, whose surface is rough and cannot be discharged by themselves, or who have ureteral stricture and infection.
Prevention:
Dietary health care
(1) The daily water consumption is 2000-3000ml, and it will be increased to 4000-5000ml in hot summer, and it will be increased after sweating, and at least the daily urine output will be kept above 2000ml.
② Magnetized water can be used for drinking, which is easy to disintegrate stones.
③ Eat more foods containing vitamin A, such as pork liver, eggs, fresh cabbage and fruits.
Eat less foods rich in calcium, such as kelp, auricularia auricula, beans, amaranth, milk, celery, laver, eel, salted radish, pumpkin seeds, dried red dates, etc.
⑤ Eat less foods rich in oxalic acid, such as spinach, celery, cocoa, coffee, beets, grasses, oranges, sweet potatoes and black tea.
⑥ Eat less foods that are easy to increase urate, cystine and xanthine, such as animal viscera, seafood, beans and peanuts.
Kidney calculi is caused by many factors, such as metabolic disorder, hyperparathyroidism, urinary tract infection, obstruction or chemical factors. Stones can be divided into oxalate stones, phosphate stones, urate stones, calcium salts and cystine stones according to their main crystal components. According to incomplete statistics in China, the composition of stones varies from place to place, and oxalate stones and phosphate stones are the most common stones. Therefore, diet should be controlled according to the nature of stones.
Oxalate stones: most of them are produced by food, and some can also be produced by endogenous mechanisms. Vegetables with high oxalic acid content, such as spinach, amaranth, water spinach, green garlic, onion, water bamboo shoots, etc., should be fasted in diet. Oral folic acid 5 mg and pyridoxine 10 mg can prevent glycine from converting into oxalic acid. Patients with this kind of stones should drink more water.
Phosphate stones: Because they are formed in alkaline urine, we should eat more acidic foods and limit foods with high calcium content. Acidic foods such as livestock and poultry meat, fish and shrimp, eggs, cereals and peanuts.
Uric acid calculus: It is caused by hyperuricemia, so foods with high purine content, such as animal viscera, thick soup, mushrooms, peas, Gracilaria lemaneiformis, sardines, anchovies and roe, should be fasted. Eat more fruits and vegetables and drink more water to reduce uric acid concentration.
Calcium calculus: milk, cheese and shrimp skin with high calcium content should be restricted. Eat more acidic foods, such as meat, poultry, eggs, etc., to make the urine acidic and drink more water.
Cystine calculus: Pay attention to limit methionine and acidic food (animal food), eat more alkaline food (plant food) to make urine alkaline and drink more water.
There are many kinds of treatment methods for kidney calculi, which need to be selected by the hospital according to the specific location and size of stones, such as drug stone removal, stone crusher, surgery, etc., so as to achieve the goal of radical cure.
(a) preventing and treating the formation and recurrence of stones
1. Removing the inducement of kidney calculi, actively treating the causes of stones, such as primary hyperparathyroidism, parathyroidectomy, treating malignant tumors, controlling renal pelvis infection and relieving urinary tract obstruction, are all effective measures to prevent the formation and recurrence of stones.
2. General therapy
(1) Ensure adequate drinking water: it is best to drink magnetized water with less minerals, so that the daily urine output exceeds 2000ml, which can dilute urine, reduce crystal precipitation, flush urinary tract and discharge tiny stones.
(2) Diet: The diet composition should be determined according to the types of stones and the pH of urine. For calcium oxalate stones, foods with high oxalic acid content, such as spinach, tomatoes, potatoes, beets, Gracilaria lemaneiformis, nuts, tea, cocoa and chocolate, should be avoided. And foods with high calcium content such as milk and cheese. For idiopathic hypercalciuria, calcium intake should be restricted to reduce urinary calcium content; For recurrent oxalate stones without hypercalciuria, a low-calcium diet is not needed. If stones are formed due to the increase of urinary oxalic acid excretion caused by low calcium diet, low calcium diet is not suitable. Control sodium intake, too much sodium intake can increase urinary calcium excretion. When hyperuricemia and hyperuricemia occur, you should eat purine diet, avoid eating animal viscera and eat less fish and coffee.
3. Drug therapy
(1) hypercalciuria: Patients caused by primary hyperparathyroidism, sarcoidosis, hyperthyroidism and multiple myeloma should be treated accordingly. Other reasons can take the following measures.
1) thiazide diuretics: hydrochlorothiazide 50 ~ 100 mg per day, or other diuretics with corresponding dosage.
2) Sodium phosphate fiber resin: 2.5 ~ 5g each time, taken while eating. At the same time, it is necessary to appropriately limit the intake of oxalic acid and supplement calcium.
3) Orthophosphate: 65438+ 0.5 ~ 2.0g phosphorus per day, taken 3 ~ 4 times. Those with glomerular filtration rate less than 30ml/min and those with urinary tract infection do not need it, because it can cause metastatic soft tissue calcification and infectious stones.
(2) Intestinal hyperoxaluria: Magnesium hydroxide or magnesium oxide can be used. Cholestyramine can correct intestinal malabsorption of fat, but it can not continuously inhibit the absorption of oxalic acid.
(3) kidney calculi containing calcium in low urine citric acid: the usage is 3 ~ 6g per day, taken three times. Some patients may have mild gastrointestinal reaction, and those with renal insufficiency should use it with caution.
(4) Uric acid calculus: Potassium citrate is the first choice in clinic, and the dosage is 30 ~ 60 mmol/d. If the blood uric acid increases at the same time, allopurinol should be added, and the blood uric acid concentration should be changed to a maintenance level after control.
(5) Cysticercosis and cysticercosis: When adequate drinking water (often > 3l/d) and alkalized urine (pH > 7.5) are ineffective, D- penicillamine can be used for treatment, with a daily dose of 1 ~ 2g. The mechanism of action of α-mercaptopropylene glycine is similar to that of D- penicillamine, but it has fewer side effects.
(6) Infectious stones: Long-term effective control of urinary tract infection can limit the formation of infectious stones and even dissolve some of the stones that have been formed. However, due to the low concentration of antibiotics in stones, bacteria can not be completely killed, and it is difficult to completely cure urinary tract infection by simple antibacterial treatment.
(2) Treatment of stones
Great progress has been made in the treatment of kidney calculi in recent years. Many kidney calculi patients who needed surgery in the past can get satisfactory results through extracorporeal shock wave lithotripsy, non-open surgery or a combination of several methods. & ltBR & gt& ltBR & gt Medical treatment For smooth round stones with a diameter less than 0.5mm, there is no urinary tract obstruction or infection, and the renal function is good, medical treatment can be used. Lithotripsy is effective for uric acid stones and cystine stones, but ineffective for calcium-containing stones and infectious stones. The routes of administration include oral administration, intravenous administration, ureteral intubation, open nephrostomy intubation and percutaneous nephrostomy intubation. During the treatment, we should closely observe the changes of the disease, make radionuclide renogram and X-ray examination regularly, understand the renal function and decide whether to operate.
(3) Symptomatic treatment
1. Atropine or 654-2 intramuscular injection can be used to treat renal colic, promethazine can enhance the curative effect, and dolantin or morphine can be used if it fails.
2. See "Urinary Tract Infection" for the treatment of urinary tract infection.
3. When gross hematuria is obvious, 0. 1~0.2g hydroxyaniline or 0. 1 ~ 0.2g tranexamic acid can be injected slowly intravenously, three times a day.