妊娠合并输尿管结石的临床处理

Clinic Management of Pregnancy Complicating Ureteral Calculi

目的探讨妊娠合并输尿管结石的临床治疗方法。方法回顾性分析作者医院2010-12/2012-12月35例妊娠合并输尿管结石患者的临床资料。患者平均年龄为25岁（19~38岁）,平均妊娠时间为26周（12~38周）。结果在所有患者中,12例采用了保守治疗,其中8例（22.9%）自发将结石排出,4例（11.4%）症状自发缓解,但未见明显结石排出。另外23例因反复肾绞痛或肾积水加重而采用了手术治疗,其中18例采用了持续硬膜外麻醉下输尿管镜联合气压弹道碎石术或双J管留置术,5例采用了局部麻醉下单纯双J管留置术。术后所有患者均没有出现严重的产科或泌尿系并发症。结论妊娠合并输尿管结石首选保守治疗;保守失败的情况下,输尿管镜下碎石或置管术治疗妊娠期输尿管结石患者安全、有效。

Objective To study the clinical treatment of pregnancy with ureteral calculi. Methods A retrospective analysis of the clinical data of 35 pregnancy women with ureteral calculi between December 2010 and December 2012 was performed. The average age of the patients was 25 （19-38） years old, the average pregnancy time was 26 （12-38） weeks. Results Twelve patients received conservative treatment, and8 cases （22. %） spontaneously discharged the stones. Four cases （11.4 % ） relieved spontaneously, but no obvious stones were observed. The other 23 cases received invasive man- agement because of repeated renal colic or aggravated hydronephrosis, among whom 18 cases were treated by ureteroscopy combinded with pneumatic lithotripsy or pure double J tube indwelling under continuous epidural anesthesia, and the other 5 cases accepted pure double J tube indwelling surgery under local anesthesia. All patients had no severe obstetric or uri- nary complications after the operation. Conclusion Conservative treatment is preferred for the pregnancy women with u- reteral calculi. And when conservative treatment fails , the ureteroscopy or double J tube indwelling is safe and effective for the patients.