妊娠期症状性肾积水的腔内微创诊疗方案分析

Analysis of minimally invasive diagnosis and therapy for symptomatic hydronephrosis during pregnancy

目的:探讨症状性妊娠期肾积水的腔内微创诊疗方案。方法:对143例保守治疗无效的症状性妊娠期肾积水患者的临床资料进行回顾性分析,65例妊娠期肾积水合并感染患者采用输尿管镜检双J管置入术,78例为妊娠期输尿管结石、肾积水,采用输尿管镜检钬激光碎石术或气压弹道碎石术。结果:143例患者临床症状均明显缓解,65例合并感染患者顺利置入输尿管双J管后症状缓解;78例输管结石患者碎石成功73例(93.6%);143例患者中症状复发者5例(3.5%),双J管下移3例(2.1%),输尿管穿孔2例(1.4%)。结论:在保守治疗无效时,妊娠期肾积水合并感染可采用输尿管双J管置入引流,同时抗感染治疗,效果确切;妊娠期输尿管结石患者采用输尿管镜检钬激光碎石或气压弹道碎石术疗效均安全可靠。

Objective:To explore the minimally invasive diagnosis and treatment for symptomatic hydronephrosis during pregnancy.Methods:The clinical data of 143 cases of pregnancy with symptomatic hydronephrosis who had failed to respond the conservative treatment were retrospectively analyzed.In 65 cases of hydronephrosis combined with infection during pregnancy,the double J tube was inserted under the ureter endoscope.In 78 cases ureteral calculi-induced symptomatic hydronephrosis during pregnancy was treated with the holmium laser lithotripsy or pneumatic lithotripsy.Results:The clinical symptoms were relieved obviously in 143 patients.In 65 cases of symptomatic hydronephrosis combined with infection,the symptoms were relieved after successfully inserting the double J tube.Seven-three cases out of 78 cases of ureteral calculi-induced symptomatic hydronephrosis(93.6%)were successfully treated by ureteral lithotripsy.There were 5cases(3.5%)with recurrent symptoms in 143 patients,3cases(2.1%)with double J tube movement downward,and 2cases with ureteral perforation(1.4%).Conclusions:Double J tube insertion is an effective treatment for symptomatic hydronephrosis combined with infection during the pregnancy when conservative treatment is invalid.The treatment of ureteral calculi during the pregnancy with holmium laser lithotripsy or pneumatic lithotripsy is safe and reliable.