微创技术治疗孕期输尿管结石并感染的疗效探讨  

Clinical Observation of Minimally Invasive Technique in the Treatment of Ureteral Calculi during Pregnancy

作　　者：杨海超[1] 许汉标[1] 陈宣霖 石崇军[3] YANG Hai-chao;XU Han-biao;CHEN Xuan-lin;SHI Chong-jun(Department of General Surgery,Huizhou Second Maternal and Child Health Care Center,Huizhou,Guangdong Province, 516008 China;Guangdong Medical University,Zhanjiang,Guangdong Province,524023 China;Department of Urology,The Third People's Hospital of Huizhou,Guangdong Province,516002 China)

机构地区：[1]惠州市第二妇幼保健院综合外科,广东惠州516008 [2]广东医科大学,广东湛江524023 [3]惠州市第三人民医院泌尿外科,广东惠州516002

出　　处：《中外医疗》2019年第12期89-91,共3页China & Foreign Medical Treatment

摘　　要：目的研究微创技术治疗孕期输尿管结石合并感染的疗效。方法方便选择2010年3月-2017年6月该医院收治的孕期输尿管结石并感染的患者40例,均采用微创技术治疗。根据患者的实际情况选择治疗方法,其中,15例患者单纯留置双J管,23例患者行输尿管镜下钬激光碎石术,2例患者行经皮肾穿刺造瘘术。对所有患者临床资料进行回顾性分析,观察患者的治疗效果。结果所有患者治疗后,急性症状如发热、肾绞痛等均消失。23例患者结石一次性取净;15例患者留置双J管,其中4例患者分娩前排出结石,并拔除双J管,11例患者分娩后再行微创手术;2例患者行经皮肾穿刺造瘘术,分娩后再行微创手术,两组差异有统计学意义(χ^2=6.214,P=0.02)。所有患者均顺利分娩,婴儿均健康。患者术后定期进行B超复查,每月1次,其中4例单纯置管患者仍存在轻度肾积水,其余患者肾积水症状均消失。未出现早产、流产等不良妊娠结局,未发生输尿管穿孔、输尿管狭窄、感染性休克、肾破裂、泌尿系出血等严重并发症,差异无统计学意义(t=1.140,P=1.02)。置入双J管的患者的疼痛VAS评分为(1.35±1.38)分,经皮肾穿刺造瘘术患者的疼痛VAS评分为(2.46±1.62)分,差异有统计学意义(t=3.727,P=0.02)。结论在孕期输尿管结石并感染的治疗中,根据患者的实际情况合理运用微创技术,可达到较满意的效果,且具有较高的安全性。Objective To study the efficacy of minimally invasive technique in the treatment of ureteral calculi complicated with infection during pregnancy. Methods March 2010 to June 2017, a total of 40 cases of pregnant ureteral calculi complicated with infection were convenient selected and treated with minimally invasive techniques. According to the actual situation of the patients, the treatment methods were selected. Among them, 15 patients simply retained double J tubes, 23 patients underwent holmium laser lithotripsy under ureteroscope, and 2 patients underwent percutaneous nephrostomy. The clinical data of all patients were retrospectively analyzed to observe the therapeutic effect of the patients. Results After treatment, acute symptoms such as fever and renal colic disappeared in all patients. Twenty-three patients had stones removed at one time. Fifteen patients had double J tubes detained, of which 4 patients had stones removed before delivery and11 patients had minimally invasive surgery after delivery. Two patients had percutaneous nephrostomy and minimally invasive surgery after delivery. The difference between the two groups was statistically significant(χ^2=6.214,P=0.02). All patients gave birth smoothly and the baby was healthy. B-mode ultrasonography was performed regularly after operation, once a month. Among them, 4 patients with simple catheterization still had mild hydronephrosis, and the symptoms of hydronephrosis disappeared in other patients. There were no adverse pregnancy outcomes such as premature delivery and abortion, and there were no serious complications such as ureteral perforation, ureteral stricture, septic shock, renal rupture, urinary bleeding, etc. There was no significant difference(t=1.140,P=1.02). The pain VAS score of patients with double J tube implantation was(1.35±1.38)points and that of patients with percutaneous nephrostomy was(2.46±1.62)points. The difference was statistically significant(t=3.727,P =0.02). Conclusion In the treatment of ureteral calculi complicated with

关 键 词：微创技术 孕期 输尿管结石 感染 疗效 

分 类 号：R714.258[医药卫生—妇产科学] R699.4[医药卫生—临床医学]