輸尿管內(nèi)支架管置入處理妊娠合并上尿路梗阻26例分析

【摘 要】 目的 分析妊娠合并輸尿管梗阻的患者，評(píng)估經(jīng)膀胱鏡留置輸尿管內(nèi)支架管處理輸尿管梗阻的效果。方法 回顧性分析26例妊娠期合并上尿路梗阻的臨床資料，26例臨床表現(xiàn)為腰腹部疼痛，均伴有畏寒、發(fā)熱、白細(xì)胞升高等感染癥狀；26例均有不同程度腎積水，B超檢查發(fā)現(xiàn)結(jié)石14例，未發(fā)現(xiàn)結(jié)石12例。結(jié)果 26例均為經(jīng)保守治療后，癥狀無緩解，經(jīng)膀胱鏡輸尿管支架管置入后，癥狀均得到控制，留置內(nèi)支架管時(shí)間為14-180天，置管前證實(shí)死胎1例，置管后流產(chǎn)1例，置管后結(jié)石排出者8例，24例孕婦無產(chǎn)科并發(fā)癥并娩出健康嬰兒。結(jié)論 妊娠期輸尿管梗阻可導(dǎo)致上尿路感染，采取輸尿管內(nèi)支架置入盡早解除梗阻是有效安全的外科處理手段。

【關(guān)鍵詞】 妊娠；上尿路梗阻；感染；留置輸尿管內(nèi)支架管

【中圖分類號(hào)】 R714.25 【文獻(xiàn)標(biāo)識(shí)碼】 B

Clinical Analysis of Ureteral Stent Placement for the Treatment of 26 Patients with Upper Urinary Tract Obstruction during Pregnancy

Zhang Hongjing Wang Chunhui Li Hui Zheng Ying Li Jian Shi Yunqiang*

（Department of Urology，The Yan'an Affiliated Hospital of Kunming Medical University，Kunming，China）

【Abstract】 Objective To explore the clinical efficacy of ureteral stent for the treatment of upper urinary tract obstruction during pregnancy.Meathods Retrospective analysis of clinical data on 26 cases of pregnant women with urinary tract obstruction，clinical manifestations 26 cases of lumbar abdominal pain，were accompanied by chills，fever，leukocytosis and other symptoms of infection；26 cases of varying degrees of hydronephrosis，B ultrasound found stones in 14 cases，12 cases of were not found.Results The symptoms of 26 cases were not relieved after conservative treatment.After cystoscopy ureteral stent placement，the symptoms are under control， indwelling stent tube for 14 to 180 days.Fetal death before stent implantation confirmed one case，the stent after implantation abortion one case，stones removed in 8 cases，24 cases of pregnant women without obstetric complications and delivered a healthy baby.Conclusion Ureteral obstruction during pregnancy can lead to urinary tract infection，take the ureteral stent placement as soon as possible to relieve the obstruction is safe and effective surgical treatment options.

【Keywords】 pregnancy；upper urinary tract obstruction； infection；ureteral stent placement

妊娠期隨著子宮體積增大，對(duì)周圍組織的壓迫也相應(yīng)增大，增大的子宮壓迫輸尿管或是腎盂就會(huì)引起輸尿管引流不暢，引起全身菌血癥、敗血癥甚至導(dǎo)致流產(chǎn)、死胎，如果積水嚴(yán)重可以導(dǎo)致孕婦腎功能損害，嚴(yán)重威脅胎兒及孕婦生命安全[1]。解除輸尿管梗阻，可避免因輸尿管梗阻引起的嚴(yán)重并發(fā)癥。本文分析了我院2010年3月至2013年10月收治的26例妊娠期合并輸尿管梗阻患者的診治過程，現(xiàn)作一報(bào)道。

1 臨床資料

本組26例，年齡23-42歲，平均29.4±1.2歲。有腎結(jié)石病史10例，妊娠早期（<12足周）者1例，妊娠中期（13-27足周）者20例，妊娠晚期（≥28周）者5例。首次妊娠24例，二次妊娠2例。所有孕婦均無妊娠合并癥，無心臟病及高血壓，否認(rèn)藥物過敏史及手術(shù)外傷史。……