妊娠期合并泌尿系结石临床治疗分析
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摘要
目的总结妊娠期合并泌尿系结石安全有效的治疗方法。方法回顾性分析98例妊娠期合并泌尿系结石的病例资料,所有患者均给予黄体酮、6-542肌注及抗生素等保守治疗,失败者膀胱镜下留置输尿管内双J管治疗,再失败则肾穿刺造瘘术。结果保守治疗24h内症状缓解、1个月内结石排出51例(52.0%);因保守治疗失败给予留置输尿管内双J管治疗47例(48.0%),其中,留置双J管失败行肾穿刺造瘘术6例(6.1%)。47例患者留置双J管24h内症状均明显缓解,1个月内结石完全排出16例,3个月结石完全排出30例,因妊娠结束结石未排出接受碎石治疗17例;置管期间出现膀胱刺激征及发热3例,考虑导管相关性感染,予抗感染治疗后症状均缓解。所有患者治疗期间耐受性良好,无严重的并发症发生,无妊娠期内接受输尿管镜下钬激光碎石术治疗的病例。结论妊娠合并泌尿系结石,首选保守治疗,若保守治疗无效,膀胱镜下输尿管内置双J管或经皮肾穿刺造瘘术均是安全有效的治疗方法。
Objective To search for an effective and safe treatment for urinary system stone disease in pregnant women. Methods Clinical data of 98 cases of urinary system stone disease in pregnant women were analysed retrospectively.All patients were given conservative treatment of progesterone,6- 542 intramuscular injection and antibiotics. If the conservative treatment was failure,the patients were indwelt double J stenting( DJS) under cystoscope; if it failed again,and then give percutaneous nephrostomy( PCN). Results After conservative treatment,51 patients achieved remission of symptoms and the stones were completely discharged in 1 mouth. 47 patients( 48. 0%) indwelt DJS after the failure of conservative treatment. Among them,6 cases( 6. 1%) with failure of indwelling DJS were given PCN. The symptoms of 47 patients with indwelling DJS were significantly alleviated within 24 hours; 16 cases exhausted all stones in 1 month; 30 cases completely discharged in 3months stones; 17 patients due to the end of pregnancy,but the stone had not yet discharged,and then accepted lithotripsy treatment; bladder irritation and fever occurred in 3 patients during the treatment,consider catheter-related infection,and the symptoms were relieved after anti infection treatment. All patients were well tolerated and no severe complications occurred during the period of the treatment. There were no patients during pregnancy underwent holmium laser lithotripsy through ureteropyeloscopy. Conclusion It is advisable that conservative treatment is preferred to pregnancy associated with urinary calculi. If conservative treatment is invalid,DJS or PCN is also safe and effective.
Objective To search for an effective and safe treatment for urinary system stone disease in pregnant women. Methods Clinical data of 98 cases of urinary system stone disease in pregnant women were analysed retrospectively.All patients were given conservative treatment of progesterone,6- 542 intramuscular injection and antibiotics. If the conservative treatment was failure,the patients were indwelt double J stenting( DJS) under cystoscope; if it failed again,and then give percutaneous nephrostomy( PCN). Results After conservative treatment,51 patients achieved remission of symptoms and the stones were completely discharged in 1 mouth. 47 patients( 48. 0%) indwelt DJS after the failure of conservative treatment. Among them,6 cases( 6. 1%) with failure of indwelling DJS were given PCN. The symptoms of 47 patients with indwelling DJS were significantly alleviated within 24 hours; 16 cases exhausted all stones in 1 month; 30 cases completely discharged in 3months stones; 17 patients due to the end of pregnancy,but the stone had not yet discharged,and then accepted lithotripsy treatment; bladder irritation and fever occurred in 3 patients during the treatment,consider catheter-related infection,and the symptoms were relieved after anti infection treatment. All patients were well tolerated and no severe complications occurred during the period of the treatment. There were no patients during pregnancy underwent holmium laser lithotripsy through ureteropyeloscopy. Conclusion It is advisable that conservative treatment is preferred to pregnancy associated with urinary calculi. If conservative treatment is invalid,DJS or PCN is also safe and effective.
引文
[1]张磊,王小方.妊娠合并泌尿系结石50例诊治体会[J].医学信息,2014,27(11):296-297.
[2]宋灵敏,周逢海,常德辉,等.妊娠期泌尿系结石的诊治研究进展[J].中国医师杂志,2014,16(4):571-573.
[3]Yasar B,Haluk S,Murat A,et al.Effective ness and safety of ureteroscopy in pregnant women:a comparative study[J].Urolithiasis,2013,41(3):37-42.
[4]李凤英.妊娠合并泌尿系结石治疗体会[J].中外女性健康(下半月),2013,(6):41.
[5]毛郁蕾,徐峰.妊娠合并泌尿系结石先兆早产45例临床分析[J].中国乡村医药,2011,18(10):23.
[6]Olivera ST,Gjulsen S,Katica Z.Obstructive nephropathy as a result of malignant neoplasms:A single centre experience[J].Bantao J,2010(8):71-74.
[7]陈文忠,桂志明,何锦园,等.妊娠期尿路结石的治疗[J].临床泌尿外科杂志,2011,26(11):849-851.
[8]那彦群,叶章群,孙光.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:154.
[9]毛美亚,徐科君,张富斌,等.妊娠期合并泌尿系结石的疗效观察[J].现代实用医学,2012,24(12):1385.
[10]Semins MJ,Trock BJ,Matlaga BR.The safety of ureteroscopy during pregnancy:a systematic review and meta-analysis[J].J Urol,2009(181):139-143.
[11]Semins MJ,Matlaga BR.Management of stone disease in pregnancy[J].Curr Opin Urol,2010,20(2):174-177.
[12]Srirangam SJ,Hickerton BV,Cleynenbreugel B.Management of urinary calculi in pregnancy:a review[J].J Endourol,2008,22(5):867-875.
[2]宋灵敏,周逢海,常德辉,等.妊娠期泌尿系结石的诊治研究进展[J].中国医师杂志,2014,16(4):571-573.
[3]Yasar B,Haluk S,Murat A,et al.Effective ness and safety of ureteroscopy in pregnant women:a comparative study[J].Urolithiasis,2013,41(3):37-42.
[4]李凤英.妊娠合并泌尿系结石治疗体会[J].中外女性健康(下半月),2013,(6):41.
[5]毛郁蕾,徐峰.妊娠合并泌尿系结石先兆早产45例临床分析[J].中国乡村医药,2011,18(10):23.
[6]Olivera ST,Gjulsen S,Katica Z.Obstructive nephropathy as a result of malignant neoplasms:A single centre experience[J].Bantao J,2010(8):71-74.
[7]陈文忠,桂志明,何锦园,等.妊娠期尿路结石的治疗[J].临床泌尿外科杂志,2011,26(11):849-851.
[8]那彦群,叶章群,孙光.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:154.
[9]毛美亚,徐科君,张富斌,等.妊娠期合并泌尿系结石的疗效观察[J].现代实用医学,2012,24(12):1385.
[10]Semins MJ,Trock BJ,Matlaga BR.The safety of ureteroscopy during pregnancy:a systematic review and meta-analysis[J].J Urol,2009(181):139-143.
[11]Semins MJ,Matlaga BR.Management of stone disease in pregnancy[J].Curr Opin Urol,2010,20(2):174-177.
[12]Srirangam SJ,Hickerton BV,Cleynenbreugel B.Management of urinary calculi in pregnancy:a review[J].J Endourol,2008,22(5):867-875.