妊娠合并输尿管结石并发顽固性肾绞痛的急诊处理

妊娠合并输尿管结石并发顽固性肾绞痛的急
诊处理
作者：高剑宫敬杨勇罗冬喜曾斌陈磊钱芳孙建萍
【摘要】目的探讨妊娠合并输尿管结石并发顽固性肾绞痛安全有效的急诊处理方法。

方法 1997～2006年妊娠合并输尿管结石致肾绞痛经解痉镇痛治疗无效患者16例，年龄22～36岁，平均27岁，初诊时孕7～35周，平均27周。

结石最大径4～15.5 cm。

其中1例为独肾，1例并发发热，1例为双侧输尿管下段结石，患侧轻度肾积水8例，中度肾积水9例，均在局麻下在膀胱镜或输尿管镜下逆行置入输尿管双J管治疗。

结果 15例患者在置入输尿管双J管后肾绞痛症状均缓解，1例出现间歇性肉眼血尿，有间断轻微肾绞痛，予解痉治疗可缓解，1例患者双J管自动滑出，反复置管2次。

16例孕妇均顺利分娩。

结论妊娠合并输尿管结石并发顽固性肾绞痛，采用放置输尿管双J管治疗，安全有效。

【关键词】妊娠输尿管结石肾绞痛
Emergency treatment of refractory renal colic due to ureteric calculi during pregnancy
［Abstract］ Objective To evaluate the safety and efficacy
of emergency treatment of refractory renal colic due to ureteric calculi during pregnancy.Methods From 1997 to 2006，this series included 16 pregnant women （mean age was 27 years，and age ranged form 22 to 36 years old） with renal colic had not responded to conservative measures of antispasmodics and analgesics.The mean （range） gestation time was 27（7～35） weeks at diagnosis.The ureteric calculi were 4～15.5 cm in greatest dimension.All these cases presented with symptoms such as solitary kidney （1 case），fever （1 case），bilateral lower ureter calculus（1 case），8 cases of mild hydronephrosis and 9 cases moderate hydronephrosis were observed，all of them received treatment of placing of double-J-catheter under the cystoscope or ureteroscope under local anesthesia.Results Renal colic was relieved by placing double-J-catheter under the cystoscope or ureteroscope in 15 cases，in which one case had intermittent gross hematuria and mild intermittent renal colic，which could be reliered by antispasmodics and analgesics.Double-J- catheters slid out in 1 case and was placed repeatedly.All 16 pregnant women had normal delivery.Conclusion For pregnant women with refractory renal colic due to ureteric calculi，placing double-J-catheter is safe and effective.
［Key words］pregnancy;ureteral calculi;renal colic;double-J-catheter
1997～2006年，笔者对16例妊娠合并输尿管结石并顽固性肾绞痛患者，采用了放置输尿管双J管的急诊处理，效果满意，现报告如下。

1 资料与方法
1.1 一般资料本组16例，年龄22～36岁，平均27岁。

初诊时孕7～35周，平均27周，结石最大径4～15.5 cm，16例患者均有典型肾绞痛（其中肾绞痛反复发作10例），4例伴尿频、尿急、尿痛，7例出现间断性肉眼血尿，畏寒、发热1例（体温38.2 ℃～39.3 ℃），其中1例为独肾，发生急性梗阻性无尿（血尿素氮 18.2～23.3 mmol/L，血肌酐501～729 μmol/L），其余15例患者肾功能正常，16例患者均行B超检查，2例经KUB检查，确诊为输尿管结石，1例为双侧输尿管结石，其中患侧轻度肾积水8例，中度肾积水9例，均行尿常规检查，12例患者镜下可见红细胞，1例尿培养提示大肠埃希菌生长。

1.2 治疗方法患者予利多卡因局麻后，取截石位，13例经膀胱镜放置输尿管双J管，3例膀胱镜下置管失败，改为经输尿管镜放置双J管，双J管为5F～6F型号。

其中泌尿系感染者给予青霉素400。