膀胱镜下留置双J管治疗妊娠期输尿管结石的临床观察

The clinical observation and prognosis of indwelling double J tube by cystoscope for pregnancy with ureteral calculi

目的探讨膀胱镜下留置双J管治疗妊娠期输尿管结石临床效果，并观察与分析其预后，为临床治疗提供依据。方法选取妊娠期输尿管结石患者46例，均应用膀胱镜下留置双J管治疗。观测指标为手术时间、手术基本情况、术后一周随访观察其并发症等；治疗前后48h采用视觉类比量表（VAS）对疼痛程度进行评估。观察分娩前孕妇双J管位置情况及分娩状况。结果46例患者均成功置管，平均手术时间（29．14±3．27）min。37例患者的腰部绞痛及发热等症状经治疗后均得到缓解。6例患者均于双J管置入术2个月门诊复查后更换双J管。治疗后VAS评分为（1．16±0．83）分，低于治疗前（6．93±1．02）分，差异均有统计学意义（t=9．64，P〈0．05）；治疗后肾积水和尿路感染分别为4．35％（2／46）和0．00％（0／46），低于治疗前的32．61％（15／46）和19．57％（9／46），差异均有统计学意义（Х^2=8．33、9．05，均P〈0．05）；46例孕妇均顺利生产，无流产等产科并发症。平均留置双J管（5．08±1．16）个月。结论膀胱镜下留置双J管治疗妊娠期输尿管结石创伤较小、结石清除率高、术后并发症少且安全性高、预后良好，是一种安全有效的方法。

Objective To explore the effect of the cystoscope indwelling double J tube for the treatment of pregnancy with ureteral calculi, and to observe and analyze the prognosis, and provide the basis for clinical therapy. Methods 46 pregnant women with ureteral calculi were selected. All patients were treated by cystoscope indwelling double J tube. Observation indexes were the follow -up complications after a week of operation time, operation situation, Visual analogue scale （VAS） was used to evaluate the degree of pain operation before and after treatment 48 h. To observe the pregnant women with double J tube placement and delivery status. Results 46 patients were successfully catheter, the average operation time was （ 29.14 ± 3.27 ） min. 37 patients with lumbar cramps and fever and other symptoms were relieved after treatment. 6 patients with replacement of double J tube 2 months later. After treatment, VAS score was （ 1.16 ± 0.83 ） points, which was lower than （ 6.93 ± 1.02 ） points before treatment, the difference was statistically significant （ t = 9.64, P 〈 0.05 ）. After treatment, the infection rates of hydronephrosis and urinary tract were 4.35% （2/46） and 0% （0/46） ,which were lower than before treatment [ （ 15/46,32.61% ） and 19.57% （9/46） ] ,the differences were statistically significant （Х^2 = 8.33,9.05, all P 〈 0.05 ） ;46 cases of pregnant women were smooth production, no abortion complications. The average indwelling double J tube time was （ 5. 08 ± 1.16） months. Conclusion Cystoscope indwelling double J tube for the treatment of ureteral calculi in pregnancy has less invasion, high stone clearance rate, less postoperative complications and high safety, the prognosis was good, and it is a safe and effective method.