妊娠合并输尿管结石致顽固性肾绞痛的腔内处理

Endoscopic treatment 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。肾绞痛安全有效的腔内处理方法。方法妊娠合并输尿管结石致肾绞痛经保守治疗无效患者14例，孕7～34周，平均27周。结石最大径5～12mm。输尿管上段结石8例，中段3例，下段3例。上段结石中6例单纯留置双J管，2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，3例应用输尿管镜下双频激光碎石。结果12例术后。肾绞痛消失；2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。8例未碎石患者在结石排出前每3个月更换双J管。14例孕妇均顺利生产，婴儿健康。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。

Objective To evaluate the safety and efficacy of endoscopic treatment of refractory renal colic due to ureteric calculi during pregnancy. Methods Fourteen pregnant women （gestational 7- 34 weeks ; mean ： 27weeks） with renal colic due to ureteric calculi failed to respond to conservative treatment. The ureteric calculi were 5-11 mm in greatest dimension. Eight cases had calculi in upper ureter; 3 cases in middle ureter and 3 cases in lower ureter. Six cases received intra-ureteral double-J cannula alone; 2 cases 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, 3 cases received intra-ureteral double-J cannula after ureteroscopic frequency-doubled-pulse laser lithotripsy. Results Renal colic was relieved in 12 cases after the operation. Two cases with double-J cannula alone had mild intermittent renal colic, which could be re-mitted by antispasmodics. In 8 cases those did not undergo lithotrity, double-J cannulas were replaced every 3 months until the calculi were removed. All the pregnant women had nomal delivery and gave birth to healthy children. Conclusion For pregnant women with refractory re- nal colic due to ureteric calculi, retrograde intra-ureteral cannula and ureteroscopic treatment are safe and effective.