孕期泌尿系结石的手术治疗（附26例报告）

Surgery for urinary calculi during pregnancy and report of 26 cases

目的提高临床医师对孕期泌尿系结石的诊治能力。方法回顾性总结2017年4月至2019年5月26例孕期泌尿系结石临床资料。中位年龄29.5(23~39)岁,孕期24(11~33)周,结石直径10.5(5~20)mm。首次手术行输尿管支架置入19例,经皮肾造瘘术2例,直接输尿管镜术5例。结果 5例定期更换输尿管支架至产后。2例行经皮肾造瘘术并定期更换肾造瘘管至产后。明确结石手术19例,半硬输尿管镜(URS)术4例,输尿管软镜(FURS)术6例,miniPCNL7例,microperc 2例。FURS相较于miniPCNL的住院时间更短,3(3~5)d vs 5(4~6)d,P<0.05,而miniPCNL的手术时间较FURS更短50(40~60)min vs 35(30~60)min,P<0.05。手术均成功,无主要泌尿外科和产科并发症发生。结论明确结石治疗具有提高孕期生活质量、避免产后再次手术等优点。

Objective To improve clinicians’ understanding, clinical diagnosis and treatment of urinary calculi during pregnancy. Methods The clinical data of 26 patients with urinary calculi during pregnancy from April 2017 to May 2019 were analyzed retrospectively. Patients’ median age was 29.5(23~39) years, pregnancy time was 24(11~33) weeks and stone diameter was 10.5(5~20) mm. The 19 cases of ureteral stent placement were set on the first operation, 2 cases of percutaneous fistulation, and 5 cases of direct ureteroscopy. Results 5 cases were replaced ureteral stent and till postpartum regularly and 2 cases were changed nephrostomy tube regularly. Definite calculi surgical treatment was successfully performed in19 cases. Semi-rigid ureteroscopy(URS) was performed in 4 cases, flexible ureteroscopy(FURS) in 6 cases,miniPCNL in 7 cases, microperc in 2 case, respectively. Hospital stay of FURS was shorter than that of miniPCNL, 3(3~5)days vs 5(4~6)days,P<0.05, while the operation time of miniPCNL was shorter 50(40~60) min vs 35(30~60) min,P<0.05. There was no major urological and obstetric complications during and after operation. Conclusion Definite calculi treatment can improve the quality of life during pregnancy and avoid reoperation after postpartum.