妊娠合并泌尿系统结石的临床治疗

Clinical treatment of pregnancy with urinary calculi

目的探讨妊娠合并泌尿系统结石的治疗方式及临床效果。方法收集2010年1月至2016年12月在本科治疗的62例妊娠合并泌尿系统结石患者的临床资料。所有患者均首先给予对症保守治疗,如果症状无明显缓解则行单纯双J管留置术,或在麻醉下行输尿管镜钬激光碎石术或经皮肾造瘘术。结果 20例患者经消炎、解痉等保守治疗后结石自排;14例行双J管留置术(4例患者结石自动排出,10例患者产后予以碎石痊愈);26例患者因消炎、解痉等保守治疗效果差,最终选择输尿管镜下钬激光碎石,术后3周检查结石排尽;2例行经皮肾穿刺造瘘术,产后给予碎石治疗后痊愈。所有手术患者术后均未发生泌尿外科及产科相关并发症。结论妊娠合并泌尿系统结石的处理方法优先选择保守治疗,尽可能地保证胎儿及母体安全,如果保守治疗效果差,可选择输尿管镜下钬激光碎石治疗或输尿管支架管置入术,如患者出现肾积脓且支架管置入失败可考虑行经皮肾造瘘术。

Objective Pregnancy combined with urinary calculi is a potential hazard to pregnant women and fetal development. This paper discusses the selection of treatment methods for pregnancy complicated urinary calculi. Method Selection from January 2010 to December 2016,62 cases with pregnancy with urinary calcul in our hospital patients to suit the conservative treatment, if the patient symptoms has no obvious disease Line is to give simple double-J stent implantation（URS） or the lithotomy under ureteroscope or percutaneous renal puncture fistulization（PCN）. Result Twenty patients calculi discharge automatically after conservative treatment, 14 cases were given lines of double-J tube indwelling（4 cases of calculi discharge automatically, 10 cases of postpartum give lithotripsy through treatments）, 26 cases of holmium laser lithotripsy under ureter mirror, three weeks after review calculi discharge completely; 2 cases of percutaneous renal puncture fistula were obtained after postpartum treatment. No complications of urology and obstetrics were performed during the treatment of all patients. Conclusion In pregnancy with urinary tract calculi patients first consider when choosing treatment conservative treatment, so that can ensure the safety of fetal and maternal maximum, if conservative treatment effect is poor, can choose ureteroscopy with holmium laser lithotripsy treatment or ureteral stent surgery, such as kidney empyema and stent implantation can consider to suffer kidney failure colostomy.