妊娠期输尿管结石的外科治疗

Treatment of Symptomatic Ureteral Calculi during Pregnancy

目的探讨双J管置入和输尿管镜碎石术对于保守治疗无效的妊娠期输尿管结石的治疗效果。方法回顾性分析中国医科大学附属盛京医院泌尿外科2007年1月至2015年1月收治的保守治疗无效的38例妊娠期输尿管结石患者。根据治疗方法不同分为双J管组(n=21)和输尿管镜组(n=17)。比较2种治疗方法在成功率、并发症、手术时间、治疗总费用、住院时间等方面的差异。结果双J管组成功17例(81.0%)。输尿管镜组成功15例(88.2%)。双J管组并发症发生率(14.3%)较输尿管镜组(11.8%)高。双J管组在手术时间、花费及住院时间方面均较输尿管镜组低(P<0.05)。成功施行输尿管镜手术的患者无需进一步治疗,双J管组则需要在孕妇分娩后进一步处理结石。结论输尿管镜手术和置入双J管均为治疗妊娠期输尿管结石的有效方法。输尿管镜手术成功率高,可直接处理结石,而置入双J管简便、快捷,在某些情况具有一定优势。需根据患者的不同情况选择合适的治疗方法。

Objective To present our experience with the management of symptomatic ureteral calculi during pregnancy and to compare the efficacy of two treatments ： double-J stent insertion and ureteroscopy. Methods In a retrospective study between January 2007 and January 2015,38 pregnant women were treated for symptomatic ureteral calculi in our hospital. The patients were dividad into two groups based on whether they re- ceived double-J stent insertion （n = 21 ） or ureteroscopic lithotripsy （n = 17 ）. We collected and compared the patients＇ characteristics and treat- ment outcomes, such as success ratio, rate of complications, surgical time, medical costs, and hospitalization time. Results In the double-J group, the insertion of a double-J stem was possible for 17 of 21 patients （success rate, 81.0%）. In the ureteroscopy group, 15 of 17 patients had complete calculi fragmentation （success rate, 88.2%）. Complications in the double-J stent retention group were slightly higher than in the uretemscopic litho- tripsy group. The medical costs and hospitalization time required to perform ureteroscopic lithotripsy were signiticandy higher compared to double-J stent insertion. Patients in the double-J group contended with stones after delivery. Condusion Both of double-J stent insertion and uretemscopic lithotripsy am effective for the treatment of symptomatic ureteral calculi during pregnancy. The success rate of ureteroseopy, which can directly dis- rupt stones, is higher. However, double-J stent insertion costs less and is simple and convenient. The technique that is chosen to be performed de- pends on the patient＇ s practical situation and personal preference.