妊娠合并症状性上尿路结石的诊断和治疗

Management of symptomatic upper urinary tract calculi in pregnancy

目的:探讨妊娠期症状性上尿路结石的诊断和治疗方法。方法:回顾性分析38例妊娠并发症状性上尿路结石患者的临床资料,结合文献讨论本病的临床特征和诊疗方法。结果:38例患者平均年龄25岁,31例(81.6%)为初产妇,经产妇7例,多发生于妊娠中晚期(86.8%),左侧16例,右侧19例,双侧3例。主要症状为胁腹痛和镜下血尿。超声检查发现结石23例(60.5%),11例行磁共振尿路水成像(M RU),发现结石10例(90.9%)。所有患者首先采取保守治疗,25例症状缓解,22例自行排出结石。结论:妊娠期尿石症的诊断首选超声检查,M RU是很好的补充。治疗以保守治疗为主,外科治疗首选输尿管逆行置管或经皮肾穿刺造瘘,条件成熟时也可行输尿管镜治疗。

Objective：To evaluate the diagnosis and treatment of the upper urinary tract calculi in pregnant woman. Methods ：The clinical data of 38 pregnant women complicating upper urinary tract calculi were analyzed retrospectively. Results：The average age is 25 years,31 （81.6%） patients are primiparous women,most cases （86.8%） occurred in the second or third trimester. Of the 38 patients, 19 were on the right side and 16 were on the left, 3 patients had bilateral urinary stones. Flank pain and microscopic hematuria was the most common clinical presentation. Diagnostic imaging included ultrasonography and magnetic resonance urography （MRU）,calculi were visualized in 23 of 38 （60.5 %） ultrasonographic examinations,and in 10 of 11 （90.9%） MRU studies. Management was initially conservative in all patients,resulted in resolution of symptoms in 25 women,and spontaneous passage of the stone in 22 patients. Conclusion ：Ultrasonography is the primary diagnostic tool for pregnant women complicating urolithiasis ,MRU is a very helpful modality to aid the second-line assessment. Conservative treatment is the first choice. If conservative treatment fails,an ureteral stent or percutaneous nephrostomy may be appropriate,Ureteroscopy is another choice in centres with sufficient experience.