摘要
目的探讨经尿道输尿管镜下钬激光碎石术对妊娠患者合并输尿管结石围手术期早孕两项和妊娠结局的影响。方法回顾性分析2012年1月至2017年12月在中山大学附属第三医院和东莞康华医院就诊的反复性肾绞痛早期妊娠患者27例,年龄20～39(29.1±5.6)岁,初诊平均妊娠8～13(11.8±3.2)周。结石大小6～16(10.0±5.6)mm,单侧输尿管结石25例,双侧输尿管结石2例,合并有肾结石4例。保守治疗无效,在硬膜外麻醉成功后行经尿道输尿管镜下钬激光碎石术,术后均留置双J管。结果手术均取得成功,碎石成功率100%,手术时间5～36(14.9±10.5)min。术后症状均明显缓解,无妇产科及泌尿外科相关手术并发性。术晨、术后第1天、第3天检测血清孕酮值分别为(26.2±5.8)、(25.7±8.5)、(26.3±7.5)ng/mL,人绒毛膜促性腺激素水平分别为(96 322.5±2 645.6)、(104 592.1±2 007.3)、(106 798.3±2 374.7)mIU/mL,手术前后差异无统计学意义(均P> 0.05)。术中胎心率133～170(146.4±24.7)次/min;所有患者均顺利度过妊娠及围产期,胎儿正常。结论妊娠因结石导致的顽固性肾绞痛经保守治疗无效的患者应主动接受进一步治疗,经尿道输尿管镜下钬激光碎石术对此类患者围手术期早孕两项和妊娠结局均无影响,是安全有效的治疗方法之一。
Objective The study was performed to investigate the influence of ureteroscopic holmium:YAG laser lithotripsy(UHYLL)on perioperative human chorionic gonadotropin(HCG)and progesterone levels and pregnancy outcome in pregnancy.Methods A retrospective analysis was performed on 27 patients referred to two hospitals between January 2012 to December 2017 suffering repeatability renal colic during their early pregnancy.The median age of patients was 29(20~39)years,and the median gestational duration was 11.7(8~13)weeks.Median stone size was 10(6~16)mm.25 patients with unilateral ureteral calculus(92.6%)and 2 patients with bilateral ureteral calculus(7.4%)were selected.Among them,4 patients were also suffering renal calculus(14.8%).UHYLL was proceeded in all patients when conservative treatment was noneffective.Results The successful rate of lithotripsy reached 100%and the median operation time was 15(5~36)min and 146(133~170)beats/min.No complications related to operation occurred.Serum progesterone and HCG in operational morning,the first and third postoperative day were(26.2±5.8)versus(25.7±8.5)versus(26.3±7.5)ng/mL and(96 322.5±2 645.6)versus(104 592.1±2 007.3)versus(106 798.3±2 374.7)mIU/mL,respectively.The difference between preoperative and postoperative data was not statistically significant(P>0.05).All patients had normal gestational and perinatal periods without any negative consequences.Conclusions UHYLL should be recommended to patients with refractory renal colic caused by ureteral calculus during early pregnancy when conservative treatment is invalid as it is a safe and effective method causing no influence on perioperative HCG and progesterone levels and pregnancy outcome.
作者
林慧
罗飞
陈征
庞俊
刘肖瑛
刘艳飞
黄宝琴
梅志雄
LIN Hui;LUO Fei;CHEN Zheng;PANG Jun;LIU Xiaoying;LIU Yanfei;HUANG Baoqin;MEI Zhixiong(Department of Reproductive Center,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)
出处
《实用医学杂志》
CAS
北大核心
2018年第21期3581-3584,共4页
The Journal of Practical Medicine
基金
广州市科技计划项目(编号:201607010187)
中山大学重大项目培育和新兴交叉学科资助计划项目(编号:16ykjc20)
