微创经皮肾镜取石术治疗妊娠期输尿管上段结石  

Treatment of pregnant women with proximal ureteral caculi on minimally Invasive percutaneous nephrolithotomy

作　　者：张伦中[1] 许良余[1] 陈善群[1] 陈晓峰[1] 李强[1] 郭小勇[1] 李解方[2] 

机构地区：[1]湖南省郴州市第一人民医院泌尿外科,423000 [2]南华大学附属第一医院泌尿外科,衡阳421001

出　　处：《中国医疗前沿》2011年第5期48-49,共2页China Healthcare Innovation

摘　　要：目的探讨微创经皮肾镜取石术治疗妊娠期输尿管上段结石的可行性及临床疗效。方法 2006年7月～2009年12月,采用健侧卧位微创经皮肾镜取石术治疗7例妊娠期输尿管上段结石。表现为肾绞痛反复发作5例,反复发热、疼痛2例。结石位于左侧3例,右侧4例。结石长径0.8cm～1.7cm。中度积水5例,重度积水2例。超声引导经12肋下或11肋间穿刺肾脏建立通道。采用气压弹道碎石系统碎石。结果 7例患者肾绞痛、发热等症状完全消失。结石一次取净5例,一期取净率70.1%,2例残余少许小结石,未再取石。手术时间27～56min,平均41min。无胸腹腔损伤、肠穿孔及子宫穿孔等脏器损伤的并发症。未发生先兆流产或早产等情况,2例行人工流产术。5例术后顺利生产,随访6月～3年,婴儿健康。结论选择合适病例,微创经皮肾镜取石术治疗妊娠期输尿管上段结石可行、有效。Objective To assess the feasibility and superiority of minimally invasive percutaneous nephrolithotomy（MPCNL） in treatment of pregnant women with proximal ureteral calculi.Methods From July 2006 to December 2009,MPCNL guided by Bultrasonography was performed on 7 pregnant women with proximal ureteral caculi in contralateral position when the fetus was at 8-30 weeks of gestation（mean,23 weeks）.All the cases presented with urgent symptoms such as recurrent renal colic（5 cases） and recurrent renal colic with fever（2）.Of 7 cases,the stones（lenth of stones,0.8-1.7cm） were found on the left side in 3 cases,on the right in 4,Moderate hydronephrosis were observed in 5 cases and heavy hydronephrosis in 2.Results All the symptoms in 7 cases were relieved after treatment.The stonefreerate was 70.1%（5/7） on one session.In two cases,a few residual renal stones were found after the first operation,but no second operation was performed.Average operative time was 41 minutes（ranged from 27 to 56 minutes）.In this series,no threatened abortion,premature delively or complications such as chest or abdominal injuries,intestinal or uterine perforation,or injuries to surrounding organs occurred.Artificial abortion was performed in 2 cases in postoperation.Of 7 patients,five patients had normal delively and gave birth to healthy children.Conclusions Selected patients,minimally invasive percutaneous nephrolithotomy is a feasible and effective method for the treatment of pregnant women with proximal ureteral caculi.

关 键 词：输尿管上段结石 妊娠 微创经皮肾镜取石术 

分 类 号：R714.25[医药卫生—妇产科学]