妊娠期肾绞痛的输尿管镜治疗

The emergency ureteroscopic treatment of renal colic during pregnancy

目的探讨输尿管镜技术在妊娠肾绞痛治疗中的意义。方法 2007年10月～2011年10月收治妊娠肾绞痛患者259例,161例因保守治疗无效接受输尿管镜治疗,孕周13～38周,平均24.67周。结果 139例发现结石,其中输尿管上段结石43例、下段结石87例、双侧上段结石9例,结石大小0.5～2.3cm,术后24h肾绞痛症状消失者136例,其余3例术后24～72h疼痛症状缓解,短期肉眼血尿28例,发热12例,留置输尿管双J管2～12周,无输尿管穿孔与损伤;随访妊娠情况:流产4例、早产5例、剖宫产27例、经阴道产103例,无胎儿畸形及发育异常。结论输尿管镜治疗妊娠期肾绞痛,具有减少解痉镇痛用药量、快速引流尿液、缓解腰腹疼痛、保护患肾功能、保障母胎发育的特点,术中适当应用气压弹道或超声碎石是安全的。

[Objective] To explore the effect of ureteroscopic treatment of renal colic during pregnancy.[Method] From October 2007 to October 2011,259 cases of pregnant women with renal colic,161 cases （gestational 13-38weeks,mean 24.67 weeks） accepted ureteroscopic treatment for expectant treatments without effectiveness were treated.[Results] Calculi were found in 139 case,43 cases＇ calculi were located in upper ureter.87 cases＇ in lower ureter,and 9 cases＇ in upper ureter of both sides,the ureteric calculi were 0.5～2.3 cm in dimension;In 136 cases,colic disappeared in 24 hours.Symptoms disappeared in 24～72 hour in the other 3 cases.28 cases had transient gross hematuria,12 cases had fever,placed double-J tubes for 2～12 week.No case of ureter injury occurred.Pregnancy outcome：4cases were spontaneous abort,5 cases were premature delivery,27 cases were abdominal delivery and 103 cases were vaginal delivery.[Conclusion] Ureteroscopic treatment of renal colic during pregnancy can reduce dose of medicine,relief pains in abdomen and lumbus,protect renal function and development of fetus.