妊娠期输尿管结石的处理与转归  

Management and outcome of ureteral calculi in pregnancy

作　　者：胡金科 钟文[2] Jinke Hu;Wen Zhong(The First Clinical College of Guangzhou Medical University,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Urology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学第一临床学院,510120 [2]广州医科大学附属第一医院泌尿外科

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第4期377-381,共5页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探讨妊娠期输尿管结石的处理方法,并观察其术后转归情况。方法2017年7月至2021年2月,广州医科大学附属第一医院共收治204例妊娠合并输尿管结石患者。入院后均给予保守治疗,保守治疗症状无明显改善或者符合外科手术治疗指征者采用外科手术(输尿管镜检、输尿管镜碎石取石和肾造瘘)治疗,治疗前后均采用视觉模拟评分(VAS)评估患者疼痛情况。所有患者随访1年,记录患者的处理与转归情况。结果经保守治疗后83例症状缓解,产后复查显示结石排出82例,需输尿管镜碎石1例。121例外科手术治疗患者均症状缓解,其中109例结石排净,12例结石残留,产后需输尿管镜碎石9例,辅助体外碎石3例。204例患者治疗后症状和肾积水均缓解,199例分娩出正常胎儿,流产5例。随访1年,母婴均未发现明显异常,其中2例伴有肾功能不全患者经外科手术治疗后肾功能恢复正常。采用保守治疗的患者治疗后VAS评分为(1.84±0.37)分,低于其治疗前VAS评分(6.85±0.94)分(P<0.001)。采用外科手术治疗的患者治疗后VAS评分为(1.05±0.25)分,低于其治疗前VAS评分(6.89±0.96)分(P<0.001)。结论保守治疗是妊娠期输尿管结石患者的首选治疗方式,但对于保守治疗效果不佳的患者,宜尽早外科手术干预,输尿管镜取石术、输尿管置管或肾造瘘引流治疗同样安全有效。Objective To explore the management of ureteral calculi in pregnancy, and to observe the postoperative outcomes.Methods204 pregnant patients with ureteral calculi were admitted to the First Affiliated Hospital of Guangzhou Medical University from July 2017 to February 2021. Conservative treatment was administrated after admission, if symptoms had no obvious improvement, or indications of operation was noted, patitens got a surgical management, such as ureteroscopy, ureteroscopic lithotripsy and nephrostomy. Visual analog scale (VAS) was used to evaluate the pain before and after treatment. All patients were followed up for 1 year, the treatment and outcomes were recorded.ResultsThe symptoms were relieved after conservative treatment in 83 cases. 82 cases were stone free in postpartum review, and 1 case required ureteroscopic lithotripsy. 121 patients received surgical treatment and the symptoms were relieved, of which 109 cases were stone free, 9 cases required ureteroscopic lithotripsy after delivery, and 3 cases received auxiliary extracorporeal lithotripsy. Symptoms and hydronephrosis were all relived in all 204 cases, 199 cases delivered normal fetus , abortion was noted in 5 cases. In one-year follow-up, no obvious abnormality was found in mother and infant. Renal insufficiency restored to normal after surgical treatment in 2 patients. The VAS score of patients who adopted conservative treatment after treatment was (1.84±0.37), which was lower than that (6.85±0.94) before treatment (P<0.001). The VAS score of surgical patients after treatment was (1.05±0.25), which was lower than that (6.89±0.96) before treatment (P<0.001).ConclusionsConservative treatment is the first choice for ureteral calculi in pregnancy. However, surgical treatment is reqiured in patients with poor response to conservative treatment, uroteroscopic lithotripsy, ureteral stenting or percutaneous nephrostomy are also safe and effective.

关 键 词：妊娠期 输尿管结石 保守治疗 输尿管镜检术 输尿管镜碎石取石术 肾造瘘 术后转归 

分 类 号：R699.4[医药卫生—泌尿科学]