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目的探讨妊娠合并症状性上尿路结石的处理对策。方法回顾性分析我院收治47例妊娠期并发症状性上尿路结石患者的临床资料,结合文献讨论本病的临床特征和诊疗方法。结果 47例患者输尿管结石41例,左侧16例,右侧22例,双侧3例,肾结石6例,左侧2例,右侧4例。主要症状为腰腹部疼痛、肉眼血尿、发热。超声检查发现结石34例,11例行磁共振尿路水成像(MRU)发现结石,2例因顽固性腰痛伴发热行输尿管软镜检查发现结石并行钬激光碎石术。所有患者首先采取保守治疗,予以解痉、止痛、输液抗感染等治疗,9例肾积水较严重且反复发作肾绞痛予以输尿管软镜镜下钬激光碎石术,顺利;7例患者出现反复发热,其中2行膀胱镜下输尿管双J管置入术引流尿液,5例行肾穿刺造瘘引流尿液,症状均缓解;其余31例自行排出结石。47例患者均未出现流产,顺利分娩。结论妊娠期泌尿系结石诊断明确后,如果无肾盂积水、脓毒症或肾功能障碍,应首先采取保守治疗。一旦出现肾功能衰竭、脓毒症及保守治疗失败者,应行积极的外科治疗。经皮肾穿刺造瘘或逆行输尿管置管引流尿液法应为首选;输尿管软镜下手术是一种有效的治疗方法,既可以用来诊断,也可以进行有效的治疗,可作为一线治疗手段;总之,妊娠期合并上尿路结石的治疗必须个体化,要根据孕妇的一般情况、孕期、上尿路结石特点等选择合适的治疗方案。
Objective To investigate the treatment of symptomatic upper urinary tract stones during pregnancy. Methods The clinical data of 47 patients with congenital upper urinary tract stones during pregnancy in our hospital were retrospectively analyzed. The clinical features and diagnosis and treatment of this disease were discussed in combination with the literature. Results 47 cases of ureteral stones in 41 cases, 16 cases of left, right 22 cases, bilateral in 3 cases, 6 cases of kidney stones, left in 2 cases, right in 4 cases. The main symptoms of pain in the waist and abdomen, gross hematuria, fever. Ultrasound examination found 34 cases of stones, 11 cases of magnetic resonance urinary tract imaging (MRU) found stones, 2 cases of refractory lumbago with fever ureteroscopy found stones parallel holmium laser lithotripsy. All patients were treated with conservative treatment, antispasmodic, analgesic, infusion anti-infective therapy, 9 cases of hydronephrosis more severe recurrent renal colic ureteroscopic ureteroscopic holmium laser lithotripsy, smooth; 7 patients Repeated fever, including 2 lines ureter double J tube ureter drainage, 5 cases of renal puncture fistula drainage of urine, the symptoms were relieved; the remaining 31 cases of self-discharge of stones. 47 patients did not appear abortion, smooth delivery. Conclusions After the diagnosis of urinary stones in pregnancy is clear, if there is no hydronephrosis, sepsis or renal dysfunction, should be the first to take conservative treatment. In the event of renal failure, sepsis and conservative treatment failure, should be active surgical treatment. Percutaneous nephrostomy or retrograde ureteral catheter drainage should be the preferred method of urine; ureteroscopic surgery is an effective treatment, both for diagnosis, can also be effective treatment, can be used as first-line treatment ; In short, the treatment of upper urinary tract stones during pregnancy must be individualized, according to the general situation of pregnant women, pregnancy, upper urinary tract stones and other characteristics to choose the appropriate treatment.