本文選題：妊娠　切入點(diǎn)：輸尿管結(jié)石　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討妊娠期輸尿管結(jié)石的臨床特點(diǎn)及診療措施。方法:通過查閱電子病歷,收集2010年1月至2015年12月遵義醫(yī)學(xué)院附屬醫(yī)院收治的孕婦病例資料共17780例,其中自然妊娠15280例,平均年齡(25±4)歲,輔助生殖2500例,平均年齡(32±5)歲,統(tǒng)計(jì)孕前泌尿系超聲檢查應(yīng)用率、妊娠期輸尿管結(jié)石發(fā)病率,比較其在自然妊娠組與輔助生殖組孕婦有無顯著性差異;記錄妊娠期輸尿管結(jié)石孕婦的年齡、文化程度、孕期、泌尿系感染情況、臨床癥狀、輔助檢查、治療方式等觀察指標(biāo),分析妊娠期輸尿管結(jié)石與年齡、文化、發(fā)病時(shí)間的關(guān)系,總結(jié)妊娠期輸尿管結(jié)石發(fā)病的臨床特點(diǎn)及治療措施,追蹤其治療與轉(zhuǎn)歸情況,比較不同治療方式對(duì)孕期輸尿管結(jié)石臨床癥狀控制的效果。結(jié)果:輔助生殖組孕前均有泌尿系超聲檢查,自然妊娠組未做,妊娠期輸尿管結(jié)石發(fā)病率分別為0.08%(2/2500)、0.35%(53/15280),兩組孕前泌尿系超聲應(yīng)用率、妊娠期輸尿管結(jié)石發(fā)病率比較均有顯著性差異(P0.05)。自然妊娠組26歲年齡段孕婦,隨年齡降低孕期輸尿管結(jié)石發(fā)病率增高,35歲年齡段孕婦,隨年齡增加其發(fā)病率逐漸增高;不同孕期輸尿管結(jié)石發(fā)病存在差異,妊娠18~28周發(fā)病者最多,占76%(40/53);孕婦文化程度不同,發(fā)生輸尿管結(jié)石的比例也有不同,高中以下文化程度者相對(duì)較高,占67%(36/53)。泌尿系感染者占89.09%(49/55),其中34.54%(19/55)并發(fā)急性腎盂腎炎,3.63%(2/55)感染較重出現(xiàn)感染性休克。非手術(shù)治療組與手術(shù)治療組在臨床癥狀持續(xù)控制與再發(fā)生率間存在顯著性差異(P0.05),非手術(shù)組療效低于手術(shù)組;手術(shù)治療方式以局部麻醉下輸尿管內(nèi)支架植入為主,約占68.42%(13/19)。結(jié)論:妊娠期輸尿管結(jié)石總體發(fā)病率較低,但對(duì)母胎影響較大,孕前泌尿系超聲篩查有助于降低其發(fā)病率;小于26歲與大于35歲年齡段孕婦、低文化程度孕婦,妊娠期輸尿管結(jié)石發(fā)病率相對(duì)較高,其發(fā)病時(shí)間多集中于妊娠中期,多伴泌尿系感染;非手術(shù)治療效果差,局部麻醉下行輸尿管內(nèi)支架植入術(shù)可以有效控制癥狀,操作簡便、對(duì)母胎影響小、醫(yī)患均較容易接受。
[Abstract]:Objective: to investigate the clinical characteristics and diagnosis and treatment of ureteral calculi during pregnancy. Methods: 17780 cases of pregnant women admitted to the affiliated Hospital of Zunyi Medical College from January 2010 to December 2015 were collected by consulting the electronic medical records. There were 15280 cases of natural pregnancy with mean age of 25 鹵4 years, 2 500 cases of assisted reproduction, and mean age of 32 鹵5 years. The rate of urinary tract ultrasound examination before pregnancy and the incidence of ureterolithiasis during pregnancy were counted. To compare the difference between the natural pregnancy group and the assisted reproductive group, to record the pregnant women's age, education level, pregnancy, urinary tract infection, clinical symptoms, auxiliary examination, treatment methods and so on, and to record the pregnant women's age, education level, urinary tract infection, clinical symptoms, adjuvant examination, treatment methods and so on. To analyze the relationship between ureterolithiasis and age, culture, onset time during pregnancy, summarize the clinical characteristics and treatment measures of ureterolithiasis during pregnancy, and follow up the treatment and outcome of ureterolithiasis during pregnancy. Results: ultrasound examination of urinary system was performed before pregnancy in the assisted reproductive group, but not in the natural pregnancy group. The incidence of ureterolithiasis during pregnancy was 0.08 / 2500 / 0.3553 / 15280, respectively. There were significant differences in the rate of ultrasound application of urinary system before pregnancy and the incidence of ureteral calculi during pregnancy in two groups (P < 0.05). The pregnant women in the group of natural pregnancy were 26 years old, and there were significant differences in the incidence of ureteral calculi between the two groups (P < 0.05). The incidence of ureteral calculi increased with age. The incidence of ureteral calculi increased gradually with the increase of age, and the incidence of ureteral calculi varied from gestation to 1828 weeks. The incidence of ureteral calculi occurred most frequently in 1828 weeks of pregnancy, accounting for 76% 40 / 53%, and the educational level of pregnant women was different. The proportion of ureteral calculi is also different. The patients with urinary tract infection accounted for 89.09% of 49 / 55%, of which 34.54% were associated with acute pyelonephritis and 2 / 55% of acute pyelonephritis. There was a significant difference between the non-operative group and the operative group in the continuous control of clinical symptoms and the recurrence rate (P0.05%). The curative effect of operation group was lower than that of operation group. Intraureteral stent implantation under local anesthesia was the main method of surgical treatment, accounting for 68.42% and 13 / 19%. Conclusion: the overall incidence of ureteral calculi during pregnancy is lower, but the maternal and fetal effects are greater. Ultrasound screening of urinary system before pregnancy is helpful to reduce the incidence of ureteral calculi. The incidence of ureteral calculi was relatively high in pregnant women aged less than 26 years and more than 35 years old, and the incidence of ureteral calculi in pregnancy was relatively high. The incidence of ureteral calculi was mostly concentrated in the second trimester of pregnancy and accompanied with urinary tract infection, and the effect of non-operative treatment was poor. Ureteral stent implantation under local anesthesia can effectively control symptoms, is easy to operate, has little influence on mother and fetus, and is easily accepted by doctors and patients.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.258

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