双胎妊娠孕晚期合并肾绞痛诊治特点

The characteristics of diagnosis and treatment of twin pregnancy complicated with renal colic during late trimester

目的探讨双胎妊娠孕晚期合并输尿管结石肾绞痛的临床表现以及诊治方法。方法对1例双胎妊娠孕晚期合并肾绞痛患者进行回顾分析和相关文献学习。结果患者为女性,29岁,因"停经33周,下腹胀半天"入院,入院后反复腰背部疼痛,右肾区叩痛阳性,尿常规反复异常,泌尿系B超提示右肾重度积液、右输尿管上段扩张积液,结合既往病史诊断为双胎妊娠,右输尿管结石并右肾积水,经抗感染,解痉,补液,止痛保守治疗后症状有所缓解,但仍反复右侧腰背部疼痛,渐加重,通过视觉模拟评分法(VAS)评分,疼痛评分持续8~10分。泌尿外科经膀胱镜逆行输尿管双J管插管、置管术,术后肾绞痛症状明显缓解,至孕35+2周因重度妊娠期肝内胆汁淤积剖腹产分娩出双活胎。结论双胎妊娠孕晚期合并肾绞痛经保守治疗后若效果不明显,仍可行经膀胱镜逆行输尿管双J管插管、置管术,有较好的安全性和疗效。

Objective To investigate the clinical manifestations,diagnosis and treatments of ureteral calculi during late trimester of twin pregnancy. Methods A female(29 years old)suffered ureteral calculi during late trimester of twin pregnancy was analyzed. Results The patient was a 29-year-old female. She was admitted to the hospital with main complaint"33 weeks of menopause and bloating for half a day". After admission,she had repeated low back pain,positive pain in the right kidney area,and repeated abnormal urine routine. The urinary B ultrasound showed severe right kidney fluid,the right upper ureter dilated effusion. Combined with previous medical history diagnosed as twin pregnancy,right ureteral stones and stagnant water. The symptoms were relieved after conservative treatment with anti-infection,antispasmodic,fluid replacement,and pain relief,but the right lower back pain was repeated gradually aggravated. The pain score continued 8-10 points with visual analogue scale(VAS)score. Cystoscopic retrograde ureteral double J tube intubation and catheterization by Urologist,the symptoms of renal colic were significantly relieved. By 35 + 2 weeks of pregnancy,twin live births were produced accompany with severe intrahepatic cholestasis during pregnancy. Conclusion If the effect is not obvious after conservative treatment,it is still feasible to use cystoscopic retrograde ureteral double J tube intubation and catheterization in the third trimester twin pregnancy with renal colic.