输尿管镜对妊娠期单侧输尿管结石的疗效评价

目的探讨输尿管镜治疗妊娠期单侧输尿管结石的治疗效果。方法回顾分析诊断为妊娠期单侧输尿管结石的患者31例,结合患者病情及患者治疗意愿分为两组,其中输尿管镜治疗组(试验组)16例行输尿管镜检查术,术中根据情况行气压弹道碎石术或双J管置入术,保守治疗组15例行保守治疗(包括多饮水,使用黄体酮、抗生素、解痉止痛等药物),术后评价症状改善情况、结石治疗效果、分娩情况(有无先兆流产或早产)等。结果试验组总有效率90.91%,对照组总有效率60.87%,两组比较差异具有统计学意义(P0.05);随访1年,试验组所有患者均未再次出现肾绞痛;对照组有3例再次出现肾绞痛。试验组有3例分娩后再次行输尿管镜下气压弹道碎石术,1例行体外冲击波碎石术,结石排出治愈,1例出现早产;对照组有5例分娩后行输尿管镜下气压弹道碎石术,2例行体外冲击波碎石术,出现先兆流产1例,早产2例。结论输尿管镜对妊娠期单侧输尿管结石的治疗效果确切,具有微创、安全、高效的特点,可在临床中推广应用。

Efficacy evaluation of ureteroscopy for unilateral ureteral calculi during pregnancy

Objective To evaluate the therapeutic effect of ureteroscopy for unilateral ureteral calculi during pregnancy. Methods The clinical data of 31 cases undergoing ureteroscopy for unilateral ureteral calculi during pregnancy are analyzed retrospectively. According to the clinical diagnosis and patient preference,all of cases are divided into two groups. Sixteen cases in ureteroscopy group were treated by pneumatic lithotripsy or double J catheter,the others in conservative treatment group were treated by drinking more water,luteohormone,antibiotics,spasmolysis analgesic drugs and so on. Clinical evaluations included symptomatic improvement, treatment effect and delivery situation（ abortion or premature delivery）.Results Total effective rates in the treatment group and the control group were 90. 91% and 60. 87%,respectively,with significant difference. During the follow-up year,no renal colic occurred in the ureteroscopy group,while 3 cases in the conservative treatment group relapsed. In the ureteroscopy group,after delivery,3 cases were treated by secondary pneumatic lithotripsy; one case were cured by extracorporeal shock wave lithotripsy and one case had a preterm delivery. In the conservative treatment group,after delivery,5 cases were treated by pneumatic lithotripsy,2 cases were treated by extracorporeal shock wave lithotripsy,one case was caused to threatened abortion and 2 cases gave birth prematurely. Conclusion The ureteroscopic treatment of unilateral ureteral calculi during pregnancy is a mini-invasive,safe and effective method,worth clinical promotion.