妊娠期尿石症诊治安全性的临床研究  

Clinical study on the safety of diagnosis and treatment of urolithiasis during pregnancy

作　　者：徐银[1] 丁泓文[1] 陈洁[1] 都兴华[1] 石利平[1] 苏泽轩[1] 

机构地区：[1]暨南大学附属第一医院泌尿外科,广州510630

出　　处：《临床泌尿外科杂志》2015年第9期825-827,共3页Journal of Clinical Urology

基　　金：广州市重大民生攻关专项项目(编号201IY2-00003)

摘　　要：目的：回顾性分析并总结妊娠合并上尿路结石的诊治经验,评估保守治疗与手术干预两种治疗手段的安全性。方法：2011年12月2015年3月,46例孕妇因肾绞痛在我院接受治疗,治疗方法包括保守治疗、双J支架管置入术、经皮肾穿刺造瘘术（PCN）、输尿管镜碎石术（URSL）。其中31例接受解痉、镇痛及保胎等保守治疗,9例接受膀胱镜输尿管内双J管置入术,5例接受URSL,1例接受PCN。结果：31例保守治疗患者症状明显缓解,直至足月妊娠。15例采取手术干预的患者中,1例行PCN治疗者病情缓解,胎儿体征稳定;9例行双J支架管置入术者支架放置正确;5例行URSL者术后无残余碎片或残留碎片直径均小于3mm。分娩后,3例行经皮肾镜钬激光碎石术（PCNL）,9例行URSL,8例接受体外冲击波碎石术（ESWL）,以去除残留结石。所有患者均足月妊娠,母子平安,未出现严重并发症。结论：对于妊娠期上尿路结石患者,首先采取保守治疗,缓解肾绞痛等症状;当保守治疗无效时,根据患者基础情况选择双J管置入术、PCN或URSL;对于双J支架管置入术和PCN术无法解除症状的患者,URSL（特别是钬激光碎石术）更有效,应作为首选。Objective：To retrospectively analyze and summarize the diagnosis and treatment of pregnancy with urinary stones, and to evaluate the safety of conservative treatment and surgical intervention. Method： From De cember 2011 to March 2015, 46 pregnant women who suffered from renal colic were treated at our hospital. Treatment methods included conservative treatment, double-J stent implantation, percutaneous nephrostomy （PCN）, ureteroscopic lithmripsy （URSL）. Thirty-one of them accepted spasmolysis, analgesia, tocolysis and other conservative treatments. Nine of them received double J stent implantation through cystoscope. Five of them accepted URSI., and the rest one case received PCN. Result：Thirty-one cases who reveived eoncervetive treatments got significantly relieved until full term pregnancy. Among 15 cases who were taken surgical intervention, one case who received PCN relieved obviously and the fetus was fine, nine cases with douhle-J stent implantation turned to be normal, five cases receiving URSL werefft found any residual fragments or residual fragments less than 3 mm in diameter afler the operation. After childbirth in order to clean the residual fragments three cases underwent pereu- laneous nephrolithotripsy with hohnium laser, nine cases accepted URSL, and eight cases received ESWL. All patients got full term pregnancy without any severe complications. Conclusion： For pregnant women with upper urina ry calculi conservative treatments are needed at first in order to alleviate renal colic or other symptoms. When con- servalive treatments are invalid, double-J stent implantation, PCN or URSL become necessary according to patients＇ basic situation. URSL especially combined with the application of holmium laser should be the first choice if double-J stent implantation or PCN failed.

关 键 词：尿石症 妊娠期 安全性 

分 类 号：R691.4[医药卫生—泌尿科学]