[1]黎灿强,杨毅,陈志军,等.妊娠期输尿管上段结石的微创手术疗效及安全性分析[J].中华腔镜泌尿外科杂志(电子版),2018,12(03):210-213.[doi:10.3877/cma.j.issn.1674-3253.2018.03.016 ]
　Li Canqiang,Yang Yi,Cheng Zhijun,et al.Analysis of the efficacy and safety of minimally invasive management of proximal ureteral calculi during pregnancy[J].,2018,12(03):210-213.[doi:10.3877/cma.j.issn.1674-3253.2018.03.016 ]
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妊娠期输尿管上段结石的微创手术疗效及安全性分析()
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中华腔镜泌尿外科杂志(电子版)[ISSN:1006-6977/CN:61-1281/TN]

卷:
12卷
期数:
2018年03期
页码:
210-213
栏目:
临床研究
出版日期:
2018-06-20

文章信息/Info

Title:
Analysis of the efficacy and safety of minimally invasive management of proximal ureteral calculi during pregnancy
作者:
黎灿强; 杨毅; 陈志军; 徐乐
511400 广州，南方医科大学附属何贤纪念医院，广州市番禺区何贤纪念医院泌尿外科
Author(s):
Li Canqiang;  Yang Yi;  Cheng Zhijun;  Xu Le.
Department of Urology, He-Xian Memorial Hospital, Guangzhou 511400, China
关键词:
输尿管镜; 经皮肾镜; 妊娠; 肾绞痛; 输尿管结石
DOI:
10.3877/cma.j.issn.1674-3253.2018.03.016
摘要:
目的探讨微创手术治疗妊娠期输尿管上段结石的效果和安全性。方法收集 127例我院 2006年 1月至 2016年 9月接受微创手术治疗的妊娠期输尿管上段结石患者的临床资料。患者年龄 24～38岁，平均 29岁；初诊时妊娠时间 10～36周，平均 24周。患者均有典型肾绞痛症状，经常规治疗无效。采用改良的 Clavien分级系统对术后并发症进行评估分级并记录，术后复查泌尿系彩超，评估结石清除状态。结果所有患者手术过程顺利，术后肾绞痛症状均得到明显缓解，未出现先兆流产或早产、输尿管穿孔、撕脱、感染性休克及大出血等严重并发症。88例接受输尿管镜钬激光碎石术，一期清石率为 85.3 %（75/88）；11例接受彩超定位下经皮肾穿刺造瘘术，28例接受输尿管镜下双 J管置入术。术后并发症以双 J管刺激症、肉眼血尿及伤口疼痛三者发生率较高。结论妊娠期输尿管上段结石诊治过程中严格掌握适应证，施行输尿管镜碎石术安全可行，一期清石率较高，并非禁忌。此外也应根据病情及妊娠情况，选择双 J管置入或经皮肾造瘘术，以缓解肾绞痛及减轻泌尿系梗阻。

参考文献/References:

[1] Srirangam SJ, Hickerton B, Van Cleynenbreugel B. Management of urinary calculi in pregnancy: a review[J]. J Endourol, 2008, 22(5): 867-876.
[2] Z Wang, L Xu, Z Su. Invasive management of proximal ureteral calculi during pregnancy [J]. Urology, 2014, 83(4): 745-749.
[3] Mitropoulos D, Artibani W, Graefen M, et al. Reporting and grading of complications after urologic surgical procedures: an ad hoe EAU guidelines panel assessment and recommendations[J]. Eur Urol, 2012, 61(9): 341-349.
[4] 黎灿强, 徐乐, 邱敏捷, 等. S.T.O.N.E. 评分系统与经皮肾镜碎石术后并发症及结石清除状态的关系[J]. 现代泌尿外科杂志, 2015, 20(1): 44-47.
[5] Meria P, Anidjar M, Hermieu JF, et al. Urinary lithiasis and pregnancy[J]. Prog Urol, 1993, 3(6): 937-943.
[6] 杨兴业, 覃光, 刘伟. 单个输尿管结石自然排出的预测性研究[J].国际泌尿系统杂志 , 2014, 34(1): 35-38.
[7] Burgess KL, Gettman MT, Rangel LJ, et al. Diagnosis of urolithiasis and rate of spontaneous passage during pregnancy[J]. J Urol, 2011, 186(6): 2280-2284.
[8] Andreoiu M, MacMahon R. Renal colic in pregnancy: lithiasis or physiological hydronephrosis?[J]. Urology, 2009, 74(4): 757-761.
[9] 那彦群, 叶章群, 孙颖浩, 等. 中国泌尿外科疾病诊断治疗指南：2014版[M]. 北京： 人民卫生出版社 , 2014: 200.
[10] 徐遵礼, 石格荣, 窦维龙, 等. 两种腔镜术式治疗妊娠合并输尿管结石的比较[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2015, 9(6): 399-402.
[11] 王进峰, 卢晓明, 王礼平, 等. 输尿管支架置入术治疗孕期输尿管结石50例临床分析[J]. 实用临床医学, 2015, 16(6): 37-38.
[12] Ho?can MB, M Ekinci, Tun?k?ran A, et al. Management of symptomatic ureteral calculi complicating pregnancy[J]. Urology, 2012, 80(5): 1011-1014.
[13] AM Rana, S Aquil, AM Khawaja. Semirigid ureteroscopy and pneumatic lithotripsy as definitive management of obstructive ureteral calculi during pregnancy[J]. Urology, 2009, 73(5): 964-967.
[14] 温洪波, 何锦园, 丁新民, 等. 输尿管镜在妊娠期输尿管结石中的应用[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2013, 7(3): 223-225.
[15] KA Laing, TB Lam, S Mcclinton, et al. Outcomes of ureteroscopy for stone disease in pregnancy: results from a systematic review of the literature[J]. Urol Int, 2012, 89(4): 380-386.
[16] Johnson EB, Krambeck AE, White WM, et al. Obstetric complications of ureteroscopy during pregnancy[J]. J Urol, 2012, 188(1): 151-154.
[17] L Khoo, K Anson, U Patel. Success and short-term complication rates of percutaneous nephrostomy during pregnancy[J]. J Vasc Interv Radiol, 2004, 15(12): 1469-1473.

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备注/Memo

备注/Memo:
通讯作者：徐乐，Email： dr_xule@sina.com
更新日期/Last Update: 2018-06-20