妊娠期肾绞痛的诊疗分析

目的 提高妊娠期肾绞痛的诊断与治疗水平。方法 结合国内外文献,对48例首诊为妊娠期肾绞痛患者的临床资料进行回顾性分析。结果 B超发现肾积水伴输尿管结石21例,其中1例双侧输尿管结石；B超发现肾积水但未发现输尿管结石27例,其中1例首诊误诊为妊娠期肾绞痛,妊娠晚期剖宫产证实为右卵巢畸胎瘤不完全蒂扭转并卵巢部分坏死行卵巢部分切除术。35例行保守治疗有效；1例肾积水进展者、1例双输尿管结石伴双肾积水者、1例肾积脓者及9例顽固性肾绞痛者行Double J(D-J)管置入术；1例重度肾积水者行经皮肾造瘘(Percutaneous Nephrostomy, PCN)术。47例安全顺利分娩或剖宫产,1例早产。结论 妊娠期肾绞痛的诊断具有挑战性,须严格排除其他急腹症。保守治疗对大部分患者有效,但需随访肾积水进展；保守治疗无效时,D-J管置入术是一种安全、简单、有效的治疗方法。

Diagnosis and treatment of renal colic during pregnancy

Objective To review the diagnosis and treatment of renal colic during pregnancy. Methods The clinical data of 48 women who were diagnosed as renal colic during pregnancy in the first visit were retrospectively analyzed and relevant literature was reviewed. Result B-ultras-onography detected that 21 cases had hydronephrosis with ureteral stones including bilateral ureteral stones in 1 case, and 27 cases had hydronephrosis without ureteral stones. One patient with right ovarian teratoma torsion was misdiagnosed as renal colic in the first visit, and underwent partial ovariectomy after diagnosis confirmed. Thirty five cases adopted conservative treatment with satisfactory outcomes. Among remaining 13 cases, 1 case of progressing hydronephrosis, 1 case of bi-lateral ureteral stones and bilateral hydronephrosis, 1 case of pyonephrosis and 9 cases of refractory renal colic received D-J stent placement; 1 case with severe hydronephrosis received percutaneous nephrostomy (PCN). Forty seven cases underwent normal delivery or cesarean section, and 1 case had premature delivery. Conclusion Conservative management is effective in the majority of patients with renal colic during pregnancy, for patients with conservation failure placement of D-J stent is recommended.