摘要
目的观察总结妊娠期肾绞痛的特点及探讨双猪尾管在治疗中的有效性和安全性。方法回顾性分析2008年1月至2009年6月因肾绞痛就诊于北京大学第一医院泌尿外科的25例妊娠期女性患者。平均年龄为（28．3±4．9）岁，平均孕周为（20．1±6．9）周。诊治过程如下：（1）患者就诊后即予血常规、尿常规、生化检查及泌尿系超声检查；（2）给予解痉、镇痛药物（例如黄体酮等）；（3）三代头孢菌素抗炎治疗；（4）若肾绞痛未缓解，则通过膀胱镜于患侧输尿管内放置双猪尾管。置管前、置管中、置管后均有产科医师监测胎心和孕妇宫缩；（5）操作结束后，再行超声检查确认双猪尾管位置；（6）孕妇在顺利生产后，回泌尿外科复查，按常规处理结石、拔除双猪尾管。结果5例患者（20％，5／25）有结石病史或泌尿系相关手术病史。1例患者高热达40℃。84％的患者肾区叩痛阳性。6例患者（24％，6／25）尿常规镜检示大量红细胞，半数患者尿白细胞为10～20个／HP。15例（60％，15／25）血白细胞超过正常。仅1例患者血肌酐升高（为孤立肾患者）。未见血钙升高患者，8例患者（32％，8／25）血钙降低。超声检查均可显示患侧肾积水，7例患者（28％，7／25）患侧。肾脏或输尿管内发现结石。6例患者（24％，6／25）在对症止痛治疗后肾绞痛缓解，另外18例患者（72％，18／25）于膀胱镜下成功置入双猪尾管，1例孤立肾患者（4％，1／25）因置管不成功改行肾穿刺造瘘。。肾绞痛均在治疗后缓解，积水消失。患者足月生产后，按常规治疗结石或检查未发现结石即直接拔除双猪尾管。1个月后复查超声未见结石和。肾积水。结论对于妊娠期肾绞痛的患者，超声检查有结石者不多见。在对症解痉镇痛无效时，膀胱镜下逆行双猪尾管置入术能有效缓解肾绞痛，较�
Objective There is no consensus on the treatment of renal colic, a hazardous condition for both pregnant women and their fetus during pregnancy. The present study was to evaluate the therapeutic safety and efficacy of double-J stent. Methods Twenty-five pregnant women were admitted into our hospital for renal colic between January 2008 and June 2009. The mean age was （28.3 ± 4. 9） years old. And the mean gestational week was （20. 1 ± 6. 9） weeks. The diagnostic and therapeutic procedures were as follows： （1） Upon admission, routine urine and blood tests, chemistry panel and ultrasonography were performed. （2） Analgesics or antispasticity drugs were dispended to the patients, such as progesterone. （3）Magnesium sulfate was used for anti-inflammation. （4）If renal colic was not relieved, a double-J stent was inserted into the ureter via cystoscopy. At pre-, intra- and post-operation, an obstetrician monitored the fetal heart and uterine contraction. （5） Uhrasonography was conducted to check the location of double-J stent. （6） After delivery, the women underwent ESWL （ extracorporeal shock wave lithotripsy） and then the double-J stent was extracted. Results Five （20%, 5/25 ） patients had a positive previous history： three for renal calculus （ n = 3 ）, solitary kidney （ n = 1 ） and reimplantation of ureter （ n = 1 ）. Only one patient run a high fever of 40 ℃. Most patients （84%） had a positive percussion over renal regions. Only 6 patients （24%, 6/25） were found to have a great quantity of red blood cells in urine. Half of the patients showed 10 - 20 white blood cells （WBC） per high power field in urine. Fifteen patients （60%, 15/25 ） had an elevated count of WBC in routine blood test. Only one patient was with elevated serum creatinine because of her solitary kidney. The calcium level decreased in 8 patients （32%, 8/25 ）. All patients suffered hydronephrosis while 18 patients （72% , 18/25 ） were not found with calculus in ureters or ki
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第8期538-540,共3页
National Medical Journal of China
关键词
妊娠
腰痛
肾绞痛
治疗
Pregnancy
Low back pain
Renal colic
Therapy
