妊娠合并肾绞痛的诊治研究(1)
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[摘要] 目的：探讨妊娠合并肾绞痛的诊断和治疗方法。方法：回顾性分析妊娠并发肾绞痛患者36例，19例采用超声诊断和保守治疗，17例采用输尿管镜诊断和治疗。结果：19例保守治疗患者中15例治疗有效，1例因病情反复，多次治疗效果不明显而选择流产，1例由于症状反复且加重导致流产，2例因诊断不明确且病情反复而选择流产。输尿管镜诊治17例，证实输尿管结石14例，肾绞痛3例，碎石或放置双J管，17例患者均顺利度过围生期，并产健康婴儿。两组疗效间差异有统计学意义。结论：输尿管镜检术对诊治妊娠合并肾绞痛是安全、有效的。
[关键词] 妊娠；输尿管结石；诊断；治疗
[中图分类号] R691.4 [文献标识码]A[文章编号]1674-4721(2011)05(c)-022-03
Clinical diagnosis and management of refractory renal colic during pregnancy
LIU Sixin, WANG Shusong, LU Xinhong
The Hospital of Jiaonan Economic and Technological Development Zone, Shandong Province, Jiaonan 266400, China
[Abstract] Objective: To evaluate the safety and efficacy of management of refractory renal colic during pregnancy. Methods: The results of treatment of thirty-six pregnant women with renal colic were analysis retrospective. One group of nineteen patients was given by ultrasound and conservative treatment. One group of seventeen patients was diagnosis and treated by ureteroscopic. Results: Among the conservative group, 15 of 19 patients were treated successful, one choose embryotocia for the result of conservative were poor, one with embryotocia for the symptom relapse and aggravate, the other two chose embryotocia for diagnosis was not clear and symptom relapse. Among the group of ureteroscopic, 14 patients were diagnosis with ureteric calculi, 3 patients were renal colic, who were treated by lithotrity or double-J cannulas. All the pregnant women were delivered of healthy babies after safe perinatal period. There was significant statistic among the two groups. Conclusion: Ureteroscopic treatment is safe and effective for pregnant women with refractory renal colic.
[Key words] Pregnancy; Ureteral calculi; Diagnosis; Treatment
肾绞痛是泌尿外科常见的急症之一，多由泌尿系统梗阻性疾病引起。妊娠期肾绞痛临床也比较多见，因顾及胎儿的健康、发育和我国独有的计划生育政策，诊断手段和处理措施的应用较诊治普通患者受到更大限制。部分患者经常规检查甚至无法明确病因，还有部分患者虽诊断明确但经保守治疗，效果不佳，绞痛反复发作，因此成为妇产科急腹症研究的难点和热点。本科2000年8月～2007年8月收治妊娠期肾绞痛患者36例，其中19例在2004年前收治，治疗主要以保守治疗为主，治疗效果欠佳；从2004年3月始，本科与泌尿外科联合应用输尿管镜诊治妊娠期肾绞痛17例，效果满意。现将结果列出如下：
1 资料与方法
1.1 一般资料
本组36例，年龄21～35岁。初诊妊娠时间12～30周，平均21周。经超声等相关检查确认为尿道结石19例，其中包括左侧输尿管结石4例，右侧输尿管结石7例，肾结石8例。输尿管镜探查发现尿路结石14例，均为输尿管下段结石，其中右侧8例，左侧6例。肾结石大小3.5 mm×4.0 mm～10.0 mm×13.0 mm，输尿管结石横径0.3～1.0 mm。其中，上段8例，中段11例，下段17例(见表1)。均有肾绞痛发作的典型症状：腰腹部或下腹部持续性疼痛，阵发性加剧14例合并尿频、尿急，3例伴畏寒、发热，3例检查未见明显结石，考虑为炎症水肿所致梗阻。所有患者均有不同程度的肾积水。
1.2 治疗方法
1.2 ......
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