放置双J管治疗孕妇输尿管结石并发顽固性肾绞痛15例报告

The management of stubborn renal colic in pregnant women with ureteral calculi by placing double-J catheter (report of 15 cases)

目的探讨放置双J管治疗孕妇输尿管结石并发肾绞痛的疗效及安全性。方法2000-2004年行局麻下放置输尿管双J管治疗15例常规方法治疗无效的肾绞痛孕妇。患者年龄23-35岁,平均28岁。初诊时孕周8-26周,平均20周。结石最大径3-15 mm。均有典型肾绞痛症状,经解痉镇痛治疗无效。结果15例患者在膀胱镜或输尿管镜下逆行置入输尿管双J管后肾绞痛症状均缓解。其中2例双J管自动滑出,反复置管2-3次。3例存在患侧腰区轻度不适,1例出现间歇性肉眼血尿。无产科并发症。15例孕妇均顺利足月分娩。分娩后,6例发现结石自行排出, 6例行输尿管镜激光碎石术,3例行体外冲击波碎石术治疗。15例患者双J管留置时间3-7个月,平均5个月。结论对于保守治疗不能缓解的输尿管结石并发肾绞痛孕妇,置入输尿管双J管是一种安全有效的治疗方法。

Objective To evaluate the efficacy and safety of placing double-J-catheter for the man- agement of renal colic in pregnant women with ureteral calculi. Methods This series included 15 pregnant women （mean age,28 years,age range,23 -35 years） with renal colic that had not responded to conservative measures. Double-J-catheter was placed in them under local anesthesia between January 2000 and December 2004. The mean （range） gestation time was 20 （8 -26） weeks at diagnosis. The greatest dimension of the calculi ranged from 3 to 15 mm. All of them presented with typical renal colic which could not be relieved by antispasmodics and analgesics. Results Renal colic was relieved by placing double-J-catheter under the cystoscope or ureteroscope in all 15 cases. Double-J-catheters slid out in 2 cases and were placed repeatedly. Three cases had mild discomfort in the lumbar and 1 had intermittent gross hematuria. No obstetric complications occurred. All the cases experienced full-term pregnancy. After delivery the stones were elim- inated spontaneously in 6 cases. Laser lithotripsy with ureteroscope was performed in 6 cases and extracorporeal shock wave lithotripsy （ESWL） in 3 cases. The retaining time of double-J catheter was 3 - 7 months （ mean,5 months）. Conclusions For pregnant women whose renal colic cannot be alleviated by conservative methods,placing double-J-catheter is a safe and effective treatment choice.