妊娠期顽固性肾绞痛的腔内处理

目的探讨腔内诊治妊娠期肾积水合并顽固性肾绞痛的安全性和有效性。 方法回顾性分析2017年3月至2018年9月我院收治的78例妊娠期肾积水合并顽固性肾绞痛患者的病例资料。根据顽固性肾绞痛持续时间将患者分为A组（6 h以内16例），B组（6～12 h 53例）和C组（12 h以上9例）。 结果58例术中发现输尿管结石，16例（27.6%）术前彩超未见输尿管结石，行输尿管镜碎石取石和留置输尿管双J管。输尿管结石清除率87.9%（51/58）。20例未发现输尿管结石但合并肾盂结石患者，术中留置输尿管双J管。9例（11.5%）有先兆流产表现，其中A组1例（6.25%），B组4例（7.55%），C组4例（44.4%）。C组先兆流产的发生率高于A和B组（P<0.05）。1例（6.25%）患者出现尿源性脓毒血症，抗感染等对症处理后痊愈。所有患者均成功通过围产期并生产健康婴儿。 结论对于妊娠期肾积水合并顽固性肾绞痛的患者，早期输尿管镜腔内处理是有效安全的诊断和治疗手段，可降低孕妇和胎儿的风险。

Ureteroscopic management of pregnant patients with persistent renal colic

ObjectiveTo present our experiences of the ureteroscopic management for the treatment of pregnant patients with persistent renal colic. MethodsBetween March 2017 and September 2018, the data of seventy-eight pregnant women who had persistent renal colic and were treated with ureteroscopy were retrospectively analyzed. Patients were divided into three groups due to the period of the persistent renal colic: Group A (less than 6 hours, 16 cases), Group B (>6, but <12 hours, 51 cases) and Group C (>24 hours, 9 cases). The stone-free rate, complications, as well as other operative data were analyzed. ResultsFifty-eight cases (74.3%) were found ureteral stone during ureteroscopy. They were treated by ureteroscopic lithotripsy (URSL) and DJ stent insertion. 27.6% of them were not identified with ureteral calculi preoperative transabdominal ultrasound. The stone-free rate was 87.9%. The other 20 cases with renal pelvic stone were introduced DJ stent after ureteroscopy. Renal colic were absent in all case after ureteroscopic management. Cases 9(11.5%) suffered froma threatened abortion. The rates of threatened abortion in Groups A, B and C were 6.25%, 7.55%, 44.4%, respectively. Patients in Group C had higher abortion rate (P<0.05). One patient (6.25%) who suffered urosepsis in Group C was recovered after antibacterial therapy. There were no postpartum infant and maternal complications. ConclusionFor pregnant patients with persistent renal colic, ureteroscopy is an effective and safe options. Early performing can reduce the risk of preterm birth.