妊娠期顽固性肾绞痛112例内镜治疗效果分析  

Analysis of The Efficacy and Safety of Endoscopic Management of 112 Persistent Renal Colic Cases during Pregnancy

作　　者：张珂 王飞[1] 樊彩斌 孙健[1] Zhang Ke;Wang Fei;Fan Caibin;Sun Jian(Department of Urology,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215000,China)

机构地区：[1]南京医科大学附属苏州医院泌尿外科,江苏苏州215000

出　　处：《实用妇科内分泌电子杂志》2021年第25期10-14,共5页Electronic Journal of Practical Gynecological Endocrinology

基　　金：苏州市临床医学中心项目(编号Szlcyxzx202106)。

摘　　要：目的探讨内镜治疗妊娠期顽固性肾绞痛的安全性及疗效。方法回顾性分析112例使用膀胱镜及Wolf F_(4.5/6.5)硬质输尿管镜治疗妊娠期顽固性肾绞痛患者的临床资料。依据患者最终接受的手术方式将其分为膀胱镜组(69例)与输尿管镜组(43例),观察其治疗效果。结果所有患者手术顺利,术后肾绞痛得到明显缓解。膀胱镜置管术成功率为91.3%(63/69),5例改为输尿管镜置管术,1例行经皮肾造瘘术;输尿管镜检查仅1例改为经皮肾造瘘术,剩余42例术中补充发现结石8例,共38例行钬激光碎石,一期清石率为81.6%;明确2例输尿管狭窄,2例输尿管迂曲,均行输尿管支架置入。输尿管镜组手术时间长于膀胱镜组,但清石率更高,差异均有统计学意义(P<0.05);输尿管镜组分娩前支架取出率明显高于膀胱镜组,差异有统计学意义(P<0.05);两组并发症总发生率比较,差异无统计学意义(χ^(2)=0.003,P=0.960>0.05)。共3例出现早产,2例合并基础疾病,1例反复尿路感染。结论妊娠期顽固性肾绞痛采取内镜治疗安全、有效,可降低母婴风险。输尿管镜检可同时作为一种检查和治疗的方式,相比与膀胱镜置管术可快速明确病因,提高结石检出率,同时有更高的一期碎石率和分娩前支架取出率。Objective To describe the efficacy of double-J stent retention and ureteroscopy lithotripsy,we performed a study to evaluate the management of persistent renal colic during pregnancy.Methods The clinical data of 112 patients with refractory renal colic during pregnancy treated with cystoscopy and Wolf F_(4.5/6.5) rigid ureteroscopy were retrospectively analyzed.The patients were divided into cystoscopy group(69 cases)and ureteroscopy group(43 cases)according to the final operation method,and the treatment effect was observed.Results The operation was successful in all patients and renal colic was relieved significantly after operation.The success rate of cystoscopic catheterization was 91.3%(63/69).5 cases underwent ureteroscopic catheterization,and 1 case underwent percutaneous nephrostomy.Only 1 case was changed to percutaneous nephrostomy by ureteroscopy,and 8 cases of calculi were found in the remaining 42 cases.A total of 38 cases underwent holmium laser lithotripsy,and the one-stage stone removal rate was 81.6%.Ureteral stent placement was performed in 2 cases of ureteral stenosis and 2 cases of ureteral tortuosity.The operation time of ureteroscopy group was longer than that of cystoscopy group,but the stone clearing rate was higher,and the differences were statistically significant(P<0.05).The extraction rate of stents before delivery in ureteroscopy group was significantly higher than that in cystoscopy group(P<0.05).There was no significant difference in the total incidence of complications between the two groups(χ^(2)=0.003,P=0.960>0.05).There were 3 cases of preterm birth,2 cases of underlying diseases,and 1 case of recurrent urinary tract infection.Conclusion The endoscopic treatment of intractable renal colic in pregnancy is safe and effective,and can reduce the risk of the pregnant woman and the fetus.Ureteroscopy can be used as a way of examination and treatment,compared with cystoscopy,which can quickly clarify the cause and improve the stone detection rate,along with a higher rate of primary li

关 键 词：妊娠期 顽固性肾绞痛 输尿管结石 输尿管镜 

分 类 号：R714.258[医药卫生—妇产科学]