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目的探讨利用输尿管镜气压弹道碎石术治疗妊娠期输尿管结石引起上尿路梗阻的可行性及临床效果。方法对36例持续性或反复发作剧烈肾绞痛的妊娠期输尿管结石引起上尿路梗阻患者,采用输尿管镜下气压弹道碎石术治疗,观察手术疗效及安全性。结果输尿管镜下气压弹道碎石术一次性碎石成功32例,4例输尿管上段结石患者因合并脓肾予留置双J管,待患者妊娠结束后行体外冲击波碎石。术后所有患者的肾绞痛、发热等症状消失。36例均未出现流产、早产或死胎,无出现输尿管穿孔、撕脱等并发症,所有孕妇均足月分娩,新生儿发育均正常。结论输尿管镜下气压弹道碎石术治疗妊娠期输尿管结石引起上尿路梗阻能有效缓解患者疼痛,解除梗阻,且安全性高。
Objective To investigate the feasibility and clinical effect of ureteroscopic pneumatic lithotripsy in the treatment of upper urinary tract obstruction caused by ureteral calculi in pregnancy. Methods Thirty-six patients with urethral obstruction caused by ureteral calculi during or after severe persistent renal colic were treated by ureteroscopic pneumatic lithotripsy and the curative effect and safety were observed. Results The ureteroscopic pneumatic lithotripsy was successful in 32 cases of graded stones. In 4 cases, the upper ureteral stones were left with double J tube due to the complicated pyogenic kidney, and the patients were treated with extracorporeal shock wave lithotripsy after the end of pregnancy. After all patients with renal colic, fever and other symptoms disappear. None of the 36 cases had miscarriage, premature birth or stillbirth, no complications such as perforation and avulsion of the ureter. All the pregnant women gave full term delivery and their newborn development was normal. Conclusions Ureteroscopic pneumatic lithotripsy for upper ureteral obstruction during ureteral calculi during gestation can effectively relieve the pain, relieve the obstruction and have high safety.