妊娠合并输尿管结石致顽固性肾绞痛的处理

TREATMENT OF REFRACTORY RENAL COLIC CAUSED BY URETEREL CALCULI IN 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23例,孕6-34周,平均25周。结石直径4-12mm。输尿管上段结石12例,中段5例,下段6例。上段结石中9例单纯留置双J管,3例将结石推回肾盂后留置双J管。中下段结石中9例采用输尿管镜下气压弹道碎石术击碎结石,2例采用输尿管镜下套石蓝取石术,中下段病例均没有置双J管。结果：22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。12例未碎石或套石病人在结石排出前每3个月更换双J管。23例孕妇均顺利度过围产期,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碎石、取石术而不插双J管安全有效。

Objective：To investigate the ureteral calculi in pregnancy refractory renal colic caused by a safe and effective clinical treatment.Methods：Ureteral calculi in pregnancy caused by renal colic in patients with conservative treatment fails in 23 cases,6-34 weeks pregnant,25 weeks on average,stone diameter of 4-12 mm.Upper ureteral calculi in patients with 12 cases,five cases of the middle there,there are six cases of lower segment.On nine cases of ureteral calculi in a simple double-J catheter tube,the three cases of renal pelvis stones back after tube indwelling double - J. The middle and lower ureteral calculi in nine cases of the use of uret- eroscopic pneumatic lithotripsy under the shattered stones, two cases of the use of ureteroseopic stone basket under the Chengkui lithotomy, in the above cases are not under the double -J tube indwelling. Resolts ：22 cases of patients with renal colic disappeared, two -one cases of pure small tubes placed in patients with mild intermittent renal colic still taking the drug can ease the spasm. 12 cases of patients with no stone in the stone to replace every three months ago from the small two - tube. 23 cases of pregnant women through the perinatal period are smooth, and production of infant health. Conclusion ： Ureteral calculi in pregnancy - induced refractory patients with renal colic using retrograde ureteral catheterization or ureteroscopy lithotripsy, lithotomy inserted without double -J tube is safe and effective.