输尿管镜在妊娠期输尿管结石中的应用

Ureteroscopy for ureteral calculi during pregnancy

目的探讨输尿管镜在妊娠期输尿管结石中应用的安全性。方法回顾性分析我院2007年6月至2012年8月妊娠合并输尿管结石需手术干预的患者11例,中位年龄27岁(20～39岁),中位孕期27周(15～34周),经超声确诊为输尿管结石9例,结石最大径5～11mm,8例行输尿管镜取石术,3例行输尿管镜探查置管术,观察手术效果及并发症。结果所有患者术程均顺利,镜下见输尿管下段结石6例,中段2例,上段3例。中、下段者均行输尿管镜取石术取出结石,3例上段者行探查置管术,所有患者留置4.8F进口双J管,术中及术后未见明显并发症,均顺利渡过妊娠期和围生期,正常分娩(37～41周),胎儿健康。结论输尿管镜手术对妊娠期输尿管结石经保守治疗无效的患者是安全、有效的。

Objective To discuss the safety of ureteroscopy for ureteral calculi during pregnancy. Methods Eleven pregnant patients with ureteral calculi were enrolled in this retrospective study in our hospital from June 2007 to August 2012. Conservative treatment was not effective in all patients, whose median age and median gestation period were 27 years and 27 weeks repectively. Nine cases were diagnosed as ureteral calculi by ultrasound. The diameters of the stones were between 5 mm and 11 mm. Eight of them underwent ureteroscopic lithotripsy while the other 3 underwent ureteroscopy combined with double J stent placement. Results The operations were successful in all cases, and renal colic relieved after operation. Six cases of lower ureteral calculi and two cases of middle ureteral calculi underwent ureteroscopic holmium laser lithotripsy and the other 3 cases underwent ureteroscopy combined with double J stent placement. No perioperative complication occurred. All the pregnant women delivered healthy babies after safe perinatal period, with median weight of 3.5 kg. Conclusions Ureteroscopy is safe and effective for pregnant patients with ureteral ealcuci.