妊娠期肾绞痛局部麻醉下输尿管支架置入术的探讨  

Ureteral stent placement under local anesthesia for renal colic during pregnancy

作　　者：何毛毛[1] 许小兰 雷鸣[2] 李韶辉[3] 何志晖[1] He Maomao;Xu Xiaolan;Lei Ming;Li Shaohui;He Zhihui(Department of Obstetrics and Gynecology,The First Hospital Affiliated to Guangzhou Medical University,Guangzhou 510120,China;Department of Urological Surgery,The First Hospital Affiliated to Guangzhou Medical University,Guangzhou 510120,China;Anesthesiology,The First Hospital Affiliated to Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院妇产科,510120 [2]广州医科大学附属第一医院泌尿外科,510120 [3]广州医科大学附属第一医院麻醉科,510120

出　　处：《国际医药卫生导报》2021年第9期1287-1290,1360,共5页International Medicine and Health Guidance News

基　　金：广东省科技计划项目(2017ZC0223);广州医科大学附属第一医院项目(2013A03)。

摘　　要：目的探讨局部麻醉下输尿管支架置入术治疗妊娠期肾绞痛孕妇的安全性及有效性,分析本院局部麻醉下成功置入输尿管支架的经验。方法回顾性分析从2009年1月至2019年12月,在广州医科大学附属第一医院因妊娠合并肾绞痛需放置输尿管支架的孕妇资料。比较局部麻醉及静脉全身麻醉下行输尿管支架置入术后患者的临床资料和手术结局,并对局部麻醉下成功实施输尿管支架置入术的因素进行分析。结果此研究中纳入了88名孕妇,38名孕妇局部麻醉下行输尿管支架置入,50名孕妇静脉全身麻醉下行输尿管支架置入,平均年龄29岁。局部麻醉组和静脉全身麻醉组平均手术时间分别为14 min和26 min(P=0.00),两组孕妇均无术中并发症,两组孕妇术后先兆早产的发生率比较差异无统计学意义。与成功放置输尿管支架的孕妇相比,局部麻醉下未能成功放置输尿管支架的孕妇均为右侧输尿管支架置入,发病孕周在24周左右。结论妊娠合并肾绞痛孕妇局部麻醉下行输尿管支架置入术是安全有效的。该手术可节省手术时间,降低手术成本,减少静脉全身麻醉的不良反应。发病孕周晚、右侧支架置入可能是局部麻醉下输尿管支架置入失败的主要原因。Objective To investigate the efficacy and safety of ureteral stent placement under local anesthesia for pregnant women with renal colic.Methods The data of the pregnant women with renal colic placed ureteral stents at our hospital from January,2009 to December,2019 were retrospectively analyzed.The clinical data and surgical outcomes of the patients undergoing ureteral stent placement under general anesthesia and local anesthesia were compared;and the factors of successful ureteral stent placement under local anesthesia were analyzed.Results Eighty-eight pregnant women were included in the study;among which,38 underwent local anesthesia,and 50 general anesthesia.Their average age was 29.The average operation time of the local anesthesia group was 14 min,and that of the general anesthesia group 26 min(P<0.01).No intraoperative complications occurred in the two groups.There was no statistical difference in the incidence of postoperative threatened preterm labor between the two groups(P>0.05).Compared with the pregnant women who were successfully placed ureteral stents,the pregnant women who failed to be placed ureteral stents under local anesthesia were all placed on the right ureters,and had renal colic when they were about 24 weeks pregnant.Conclusions Ureteral stent placement for pregnant women with renal colic under local anesthesia is safe and effective.The operation can reduce operation time and cost and the adverse reactions of general anesthesia.Onset at late gestation age and stent placement on the right ureter under local anesthesia might cause the failure.

关 键 词：妊娠 肾绞痛 局部麻醉 输尿管支架置入 

分 类 号：R714.258[医药卫生—妇产科学]