妊娠期肾绞痛治疗方法的选择

摘要

目的 探讨妊娠期肾绞痛中不同治疗方法的效果和顽固性肾绞痛输尿管镜应用的价值.方法 42例妊娠期肾绞痛患者,首先选择休息、大量补充水、止痛、解痉、抗感染等保守治疗;无效者应用输尿管镜检查和治疗16例,放置D-J管;如置管失败,再行输尿管镜探查和碎石.结果 保守治疗26例;输尿管镜留置D-J管成功10例,并定期更换D-J管8例;妊娠期气压弹道碎石并留置D-J管6例,其中5例成功.1～2周后拔出D-J管.产后输尿管镜碎石和体外震波碎石8例.结论 保守治疗多数病例疼痛可完全缓解作为首选,应严密随访;对反复发作和顽固性肾绞痛患者,先考虑留置D-J管,尽量减少对患者刺激,以避免流产和先兆流产;必要时再行输尿管镜检查和气压弹道碎石.%Objective To discuss our experience with initial treatment in management of renal colic with or without urreteral stones in pregnant women.Methods Forty-two women with pregnancy were proved to have renal colic.Conservative treatment with hydration,analgesics and antibiotics were primarily applied.16 cases then received minimally invasive procedures,including double J-stenting and ureteroscopy,if primary treanment failed.Result Twenty-six cases got well with conservative therapies.Other 16 needed further minimally invaisve procedures,including 10 D-J stenting and 6 ureteroscopy with pneumatic lithotripsy,D-J stenting was withdrawn within 1 to 2 weeks operation.Conclusion If recurrent renal colic or failed,minimally invasive procedures of D-J stenting or further uretreoscopic pneumatic lithotripsy can facilitate the successful management of remaining cases without abortion.