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УДК 617-089
Nosirov Abdusattor Akhatovich, Sobitov Izzatullo Zabihullo ugli Tashkent Pediatric Medical Institute DOI: 10.24411/2520-6990-2020-11450 TRANSDERMAL FUNCTIONAL NEPHROSTOMY IN THE TREATMENT OF THE RENAL FORM OF PRIMARY HYPERPARATHYROIDISM IN CHILDREN
Носиров Абдусаттор Ахатович, Собитов Иззатулло Забихулло углы
Ташкентский педиатрический медицинский институт
ЧРЕСКОЖНАЯ ПУНКЦИОННАЯ НЕФРОСТОМИЯ ПРИ ЛЕЧЕНИИ ПОЧЕЧНОЙ ФОРМЫ ПЕРВИЧНОГО ГИПЕРПАРАТИРЕОИДИЗМА У ДЕТЕЙ
Abstract
For this study, a history of 2100 children with urolithiasis was carefully studied. Of these, 52 (2.47%) children were diagnosed with the renal form (RF) of PHPT based on the study of the level ofparathyroid hormone, calci-tonin, vitamin D, exercise samples with calcium and sodium chloride and scintigraphy. In this article, we tried to study the effectiveness of percutaneous puncture nephrostomy in the treatment of the renal form of primary hy-perparathyroidism in children.
Аннотация
Для проведения данного исследования было тщательно изучено история болезней 2100 детей больных мочекаменной болезнью. Из них у 52 (2,47%) детей диагностировали почечную форму (ПФ) ПГПТ на основании изучения уровня партгормона, кальцитонина, витамина Д, нагрузочных проб с кальцием и хлористым натрием и сцинтиграфии. В данной статье мы постарались изучить эффективность чрескожной пункционной нефростомии при лечении почечной формы первичного гиперпаратиреоидизма у детей.
Keywords: Pediatric surgery, urology, hyperparathyroidism, parathyroid hormone, urolithiasis Ключевые слова: Детская хирургия, урология, гиперпаратиреоидизм, паратгормон, мочекаменная болезнь
Relevance of the study: The formation of kidney stones in primary hyperparathyroidism (PHPT) is associated with an increase in the level of parathyroid hormone and cyclic adenosine monophosphate in the blood serum. Parathyroid hormone acting on the epithelium of the convoluted renal tubules upsets the balance between colloids and crystalloids [1, 2, 3]. Stones with PHPT are characterized by rapid growth, quantity and structure, obstructing the urinary passages cause pyelonephritis attacks, severe intoxication with progressive renal impairment, which complicates the tactics of surgical intervention [4, 5, 6, 7].
Objective: To evaluate the effectiveness of percutaneous puncture nephrostomy in the treatment of children with the renal form of primary hyperparathyroid-ism.
Material and methods: 2100 children with urolithiasis were examined. Of these, 52 (2.47%) children were diagnosed with the renal form (RF) of PHPT based on the study of the level of parathyroid hormone, calcitonin, vitamin D, exercise samples with calcium and sodium chloride, and scintigraphy. Of the 52 children, 31 (59.6%) children had recurrent stones, and 23 (44.2%) children had coral stones. Bilateral renal lesion with calculus was observed in 36 (69.2%) children.
Results of the study: The choice of the method of primary surgical interventions came from complications of urolithiasis and PHPT, and was aimed at restoring renal function. Preoperative preparation, primary surgical intervention and postoperative treatment required an individual approach to each patient, and was
aimed at restoring renal function and pathogenetic treatment of PHPT.
In 23 (44.2%) children out of 52, obturating stones were revealed in which there were clinical and laboratory signs of acute pyelonephritis. Of these, in 9 (39.1%) children, the choice of primary surgical care was urine diversion using percutaneous puncture nephrostomy. The indication for high urine derivation in 6 children was palpable, enlarged kidney with a sharp decrease in function ("silent kidney"). In 3 children, exacerbation of chronic pyelonephritis was accompanied (bacteremia) with a high temperature (3940 ° C), vomiting, decreased appetite, dry skin, weakness, apathy, physical developmental lag and grade II, III anemia. The kidney was enlarged, painful. There was an asymmetry of the abdomen with a lag in the act of breathing of the affected side. In this contingent of children, a sharp decrease in urine output (below 0.10 m / s) was observed on the echodoplerogram; on reno-gram and dynamic nephroscintigraphy, the decrease in the function of the affected kidney was an average of 48.5%.
This method of primary surgical treatment made it possible to avoid such formidable complications as sepsis, bacteriotoxic shock, purulent pyelonephritis, exacerbation of chronic renal failure. Percutaneous puncture nephrostomy as primary surgical care, was a gentle surgical intervention for 9 (17.3%) patients with PHPT, they have symptoms hypo - and hypercalcemia were not observed. Of the 9 (17.3%) patients who had established percutaneous nephrostomy in 8 children, the
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functional state of the kidneys was restored, parathyroidectomy in these patients was performed after the disappearance of the clinical symptoms of pyelonephritis and adequate function of the stoma kidney, up to 1 month. In 1 patient, pyonephrosis was observed with the replacement of renal tissue with fibrous tissue, kidney function did not recover, this patient underwent nephroureterectomy.
Conclusion: Thus, percutaneous puncture nephrostomy as a method of primary surgical treatment allowed to restore urodynamics, to avoid such formidable complications as sepsis, bacteriotoxic shock, purulent pyelonephritis, exacerbation of chronic renal failure, etc. percutaneous puncture nephrostomy was a sparing surgical intervention for patients with PHPT, they have symptoms of hypo and hypercalcemia not observed. Subsequent operations parathyroidectomy and removal of kidney stones went without complications.
References
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