孕期泌尿系结石的手术治疗（附26例报告）

doi:10.13418/j.issn.1001-165x.2020.01.019

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (1) : 92-96. DOI: 10.13418/j.issn.1001-165x.2020.01.019

临床研究

孕期泌尿系结石的手术治疗（附26例报告）

张际青^{1, 2}，　夏建军³，　朱惠东³，　杨明³，　彭秋平³，　张军晖^{1, 2}

作者信息 +

Surgery for urinary calculi during pregnancy and report of 26 cases

ZHANG Ji-qing^{1, 2}, XIA Jian-jun³, ZHU Hui-dong³, YANG Ming³, PENG Qiu-ping³, ZHANG Jun-hui^{1, 2}

Author information +

文章历史 +

摘要

目的　提高临床医师对孕期泌尿系结石的诊治能力。方法　回顾性总结2017年4月至2019年5月26例孕期泌尿系结石临床资料。中位年龄29.5（23~39）岁，孕期24（11~33）周，结石直径10.5（5~20）mm。首次手术行输尿管支架置入19例，经皮肾造瘘术2例，直接输尿管镜术5例。结果　5例定期更换输尿管支架至产后。2例行经皮肾造瘘术并定期更换肾造瘘管至产后。明确结石手术19例，半硬输尿管镜（URS）术4例，输尿管软镜（FURS）术6例，miniPCNL7例，microperc 2例。FURS相较于miniPCNL的住院时间更短，3（3~5）d vs 5（4~6）d，P<0.05，而miniPCNL的手术时间较FURS更短50（40~60）min vs 35（30~60）min，P<0.05。手术均成功，无主要泌尿外科和产科并发症发生。结论　明确结石治疗具有提高孕期生活质量、避免产后再次手术等优点。

Abstract

Objective To improve clinicians' understanding, clinical diagnosis and treatment of urinary calculi during pregnancy.　Methods　The clinical data of 26 patients with urinary calculi during pregnancy from April 2017 to May 2019 were analyzed retrospectively. Patients’ median age was 29.5 (23~39) years, pregnancy time was 24 (11~33) weeks and stone diameter was 10.5 (5~20) mm. The 19 cases of ureteral stent placement were set on the first operation, 2 cases of percutaneous fistulation, and 5 cases of direct ureteroscopy. Results 5 cases were replaced ureteral stent and till postpartum regularly and 2 cases were changed nephrostomy tube regularly. Definite calculi surgical treatment was successfully performed in 19 cases. Semi-rigid ureteroscopy (URS) was performed in 4 cases, flexible ureteroscopy (FURS) in 6 cases, miniPCNL in 7 cases, microperc in 2 case, respectively. Hospital stay of FURS was shorter than that of miniPCNL , 3（3~5）days vs 5（4~6）days，P<0.05 , while the operation time of miniPCNL was shorter 50 (40~60) min vs 35(30~60) min，P<0.05. There was no major urological and obstetric complications during and after operation. Conclusion Definite calculi treatment can improve the quality of life during pregnancy and avoid reoperation after postpartum.

导出引用

张际青, 夏建军, 朱惠东, 杨明, 彭秋平, 张军晖. 孕期泌尿系结石的手术治疗（附26例报告）[J]. 中国临床解剖学杂志. 2020, 38(1): 92-96 https://doi.org/10.13418/j.issn.1001-165x.2020.01.019

ZHANG Ji-qing, XIA Jian-jun, ZHU Hui-dong, YANG Ming, PENG Qiu-ping, ZHANG Jun-hui. Surgery for urinary calculi during pregnancy and report of 26 cases[J]. Chinese Journal of Clinical Anatomy. 2020, 38(1): 92-96 https://doi.org/10.13418/j.issn.1001-165x.2020.01.019

中图分类号： R691.4

参考文献

[1] Pedro RN, Das K, Buchholz N. Urolithiasis in pregnancy[J]. Int J Surg, 2016, 36(Pt D): 688-692.
[2] Semins MJ, Matlaga BR. Kidney stones during pregnancy[J]. Nat Rev Urol, 2014, 11(3): 163-168.
[3] Ishii H, Aboumarzouk OM, Somani BK. Current status of ureteroscopy for stone disease in pregnancy[J]. Urolithiasis, 2014, 42(1): 1-7.
[4] Bjazevic J, Razvi H. Stones in pregnancy and pediatrics[J]. Asian J Urol, 2018, 5(4): 223-234.
[5] Biyani CS, Joyce AD. Urolithiasis in pregnancy. I: pathophysiology, fetal considerations and diagnosis[J]. BJU Int, 2002, 89(8): 811-818.
[6] Basiri A, Nouralizadeh A, Kashi AH, et al. X-Ray free minimally invasive surgery for urolithiasis in pregnancy[J]. Urol J, 2016, 13(1): 2496-2501.
[7] Fregonesi A, Dias FG, Saade RD, et al. Challenges on percutaneous nephrolithotomy in pregnancy: supine position approach through ultrasound guidance[J]. Urol Ann, 2013, 5(3): 197-199.
[8] Drescher M, Blackwell RH, Patel PM, et al. Antepartum nephrolithiasis and the risk of preterm delivery[J]. Urolithiasis, 2019, 47(5):441-448.
[9] Shah A, Chandak P, Tiptaft R, et al. Percutaneous nephrolithotomy in early pregnancy[J]. Int J Clin Prac, 2004, 58(8): 809-810.
[10]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.
[11]Georgescu D, Multescu R, Geavlete B, et al. Ureteroscopy-first-line treatment alternative in ureteral calculi during pregnancy[J]. Chirurgia (Bucur), 2014, 109(2): 229-232.
[12]Negru I, Pricop C, Costăachescu G. Renal colic in pregnancy[J]. Rev Med Chir Soc Med Nat Lasi, 2010, 114(2): 439-444.
[13]Choi CI, Yu YD, Park DS. Ureteral stent insertion in the management of renal colic during pregnancy[J]. Chonnam Med J, 2016, 52(2): 123-127.
[14]Türk C, Neisius A, Petřik A, et al. EAU Guidelines on Urolithiasis 2018[M]. Arnhem, The Netherlands, https://uroweb.org/guideline/urolithiasis/.
[15]Lloyd GL, Lim A, Hamoui N, et al. The use of medical expulsive therapy during pregnancy: aworldwide perspective among experts[J]. J Endourol, 2016, 30(3): 354-358.
[16]Adanur S, Ziypak T, Bedir F, et al. Ureteroscopy and holmium laser lithotripsy: is this procedure safe in pregnant women with ureteral stones at different locations[J]. Arch Ital Urol Androl, 2014, 86(2): 86-89.
[17]Duvdevani M, Sfoungaristos S, Bensalah K, et al. Stones in special situations[J]. World J Urol, 2017, 35(9): 1381-1393.
[18]Biyani CS, Joyce AD. Urolithiasis in pregnancy. II: management[J]. BJU Int, 2002, 89(8): 819-823.
[19]Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: american urological association/endourological society guideline, PART I[J]. J Urol, 2016, 196(4): 1153-1160.
[20]Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis[J]. Eur Urol, 2016, 69(3): 475-482.
[21]Zhang S, Liu G, Duo Y, et al. Application of ureteroscope in emergency treatment with persistent renal colic patients during pregnancy[J]. PLoS One, 2016, 11(1): e0146597.
[22]张际青, 康宁, 邱智, 等. 超声引导穿刺辅助输尿管软镜治疗肾盏憩室结石16例并文献复习[J]. 中国临床解剖学杂志, 2016, 34(4): 460-463.
[23]Whittington JR, Simmons PM, Eltahawy EA, et al. Bladder stone in pregnancy: acase report and review of the literature[J]. Am J Case Rep, 2018, 19(12): 1546-1549.
[24]Humphries A, Mirjalili SA, Tarr GP, et al. The effect of supine positioning on maternal hemodynamics during late pregnancy[J]. J Matern Fetal Neonatal Med, 2019,32(23):3923-3930.
[25] 张际青, 张军晖, 康宁, 等. 自制F4.85可视穿刺针联合输尿管通道鞘在超微经皮肾镜碎石术中的应用[J]. 中华泌尿外科杂志, 2017, 38(11): 856.
[26]张际青, 王勇, 田溪泉, 等. 超声引导穿刺辅助输尿管软镜治疗肾盏憩室结石的临床分析[J]. 中华泌尿外科杂志, 2016, 37(2): 98-102.
[27] Hein S, Petzold R, Suarez-Ibarrola R, et al. Thermal effects of Ho: YAG laser lithotripsy during retrograde intrarenal surgery and percutaneous nephrolithotomy in an ex vivo porcine kidney model[J]. World J Urol, 2019, doi: 10.1007/s00345-019-02808-5 .
[28] Hosseini SR, Mohseni MG, Aghamir SMK, et al. Effect of irrigation solution temperature on complication of percutaneous nephrolithotomy: a randomized clinical trial[J]. Urol J, 2019, 24, 16(6):525-529.
[29] Desai M, Sun Y, Buchholz N, et al. Treatment selection for urolithiasis: percutaneous nephrolithomy, ureteroscopy, shock wave lithotripsy, and active monitoring[J]. World J Urology, 2017, 35(9): 1395-1399.