妊娠合并输尿管结石致顽固性肾绞痛的临床处理

Clinical management of refractory renal colic due to ureteric calculi during pregnancy

目的探讨妊娠合并输尿管结石致顽固性肾绞痛安全有效的临床处理方法.方法妊娠合并输尿管结石致肾绞痛经保守治疗无效患者11例,孕6～33周,平均26周.结石最大径4～11mm.输尿管上段结石6例,中段3例,下段2例.上段结石中5例单纯留置双J管,1例将结石推回肾盂后留置双J管.中下段结石中3例采用输尿管镜下气压弹道碎石术击碎结石,2例应用输尿管镜下钬激光碎石.结果10例术后肾绞痛消失;1例单纯放置双J管者仍有间断轻微肾绞痛,服用解痉药物可以缓解.6例未碎石在结石排出前每3个月更换双J管.11例孕妇均较顺利度过围产期,并产健康婴儿.结论妊娠合并输尿管结石致顽固性肾绞痛患者采用逆行输尿管插管或输尿管镜取石术安全有效.

ObjectiveTo evaluate the safety and efficacy of management of refractory renal colic due to ureteric calculi during pregnancy.MethodsEleven pregnant women (gestational 6-33 weeks;mean,26 weeks) with renal colic due to ureteric calculi failed to respond to conservative treatment.The ureteric calculi were 4-11 mm in greatest dimension.Six cases had calculi in upper ureter;3,in middle ureter and 2,in lower ureter.Five cases received intra-ureteral double-J cannula alone;1 case received intra-ureteral double-J cannula after pushing the stones into renal pelvis;3 cases received intra-ureteral Double-J cannula after ureteroscopic pneumatic lithotripsy,2 cases received intra-ureteral Double-J cannula after ureteroscopic holmium laser lithotripsy.ResultsRenal colic was relieved in 10 cases after the operation. One case with Double-J cannula alone had mild intermittent renal colic, which could be remitted by antispasmodics. In 6 cases who did not undergo lithotrity, Double-J cannulas were replaced every 3 months until the calculi were removed. All the pregnant women were delivered of healthy babies after safe perinatal period.ConclusionsFor pregnant women with refractory renal colic due to ureteric calculi, retrograde intra-ureteral cannula and ureteroscopic treatment are safe and effective.