妊娠合并输尿管结石致顽固性肾绞痛的腔内处理的论文.docVIP

　　妊娠合并输尿管结石致顽固性肾绞痛的腔内处理的论文 【摘要】 目的 探讨妊娠合并输尿管结石致顽固性肾绞痛安全有效的腔内处理方法。方法 妊娠合并输尿管结石致肾绞痛经保守治疗无效患者14例，孕7～34周，平均27周。结石最大径5～12 mm。输尿管上段结石8例，中段3例，下段3例。上段结石中6例单纯留置双j管，2例将结石推回肾盂后留置双j管。中下段结石中3例采用输尿管镜下气压弹道碎石术击碎结石，3例应用输尿管镜下双频激光碎石。结果 12例术后肾绞痛消失；2例单纯放置双j管者仍有间断轻微肾绞痛，服用解痉药物可以缓解。8例未碎石患者在结石排出前每3个月更换双j管。14例孕妇均顺利生产，婴儿健康。结论 妊娠合并输尿管结石致顽固性肾绞痛患者采用逆行输尿管插管或输尿管镜取石术安全有效。 【关键词】 妊娠；输尿管结石；肾绞痛；输尿管镜 endoscopic treatment of refractory renal colic due to ureteric calculi during pregnancy ent of urology, research institute of surgery, daping hospital, third military medical university, chongqing 400042, china) abstract: objective to evaluate the safety and efficacy of endoscopic treatment of refractory renal colic due to ureteric calculi during pregnancy.methods fourteen pregnant en (gestational 7-34 ean: 27ent. the ureteric calculi m in greatest dimension. eight cases had calculi in upper ureter; 3 cases in middle ureter and 3 cases in loatic lithotripsy, 3 cases received intra-ureteral double-j cannula after ureteroscopic frequency-doubled-pulse laser lithotripsy.results renal colic ild intermittent renal colic, itted by antispasmodics. in 8 cases those did not undergo lithotrity, double-j cannulas onths until the calculi oved. all the pregnant en had nomal delivery and gave birth to healthy children.conclusion for pregnant en ent are safe and effective. keym。左侧输尿管结石8例，右侧6例。上段8例(2例合并肾结石)，中段3例，下段3例。轻度肾积水5例，中度肾积水9例。临床诊断均为结石引起肾绞痛，呈持续性或反复间断发作，发作时疼痛剧烈，应用解痉及镇痛药物等保守治疗不能缓解。12例患者术前经b超确诊，2例输尿管中段结石患者术前未确诊，术中经输尿管镜检查确诊。 1.2 治疗方法 输尿管上段结石患者，尿道粘膜表面麻醉下经膀胱镜向??侧输尿管直接插入5 f双j管，或先插入导丝，导丝越过结石到达肾盂，导入5 f双j管。2例插入导丝失败，改用硬膜外麻醉下，引入］.济南:山东科学技术出版社，1993.622-633. ［6］ 丛 军，施卫国，董 坚.妊娠合并肾绞痛的输尿管镜钬激光治疗［j］.江苏医药杂志，2004，30（12）：955-956.