【摘要】：目的分析妊娠期輸尿管結(jié)石合并急性腎盂感染患者置入輸尿管雙J管進(jìn)行治療的效果及安全性,為臨床治療提供依據(jù)。方法選取2011年6月-2016年6月醫(yī)院收治的行經(jīng)尿道輸尿管鏡手術(shù)治療的妊娠期輸尿管結(jié)石合并急性腎盂感染患者66例,所有患者在給予抗感染治療的同時(shí)采用輸尿管鏡下置入雙J管治療,部分結(jié)石位置較好及術(shù)中感染無(wú)進(jìn)一步加重,生命體征穩(wěn)定者,予以一期行鈥激光下碎石取石術(shù),觀(guān)察其治療效果及安全性。結(jié)果 6例妊娠期輸尿管結(jié)石合并急性腎盂感染患者在行輸尿管鏡下置入雙J管治療后,體溫在1~4d內(nèi)恢復(fù)正常,白細(xì)胞計(jì)數(shù)在3~6d內(nèi)恢復(fù)正常;與置管前比較,所有患者置管后其C-反應(yīng)蛋白及前降鈣素水平均明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);5例患者術(shù)前即出現(xiàn)感染性休克,均及時(shí)轉(zhuǎn)入ICU進(jìn)行抗感染治療;感染控制后均成功進(jìn)行了輸尿管置管或鈥激光碎石治療,對(duì)急性腎盂感染的病因給予解除;所有患者內(nèi)置雙J管2~8個(gè)月后進(jìn)行拔除;對(duì)所有患者隨訪(fǎng)至分娩,其中4例患者自行要求引產(chǎn),其余患者均順利生產(chǎn),且均未發(fā)生嚴(yán)重產(chǎn)科并發(fā)癥。結(jié)論妊娠期輸尿管結(jié)石合并急性腎盂感染置入輸尿管雙J管治療安全且有效,盡早采取輸尿管雙J管置入能夠?yàn)橄乱徊捷斈蚬芙Y(jié)石處理創(chuàng)造有利條件。
[Abstract]:Objective to analyze the efficacy and safety of ureteral double J tube placement in patients with ureteral calculi complicated with acute pyelitis during pregnancy, so as to provide evidence for clinical treatment. Methods from June 2011 to June 2016, 66 patients with ureteral calculi complicated with acute renal pelvis infection were treated by transurethral ureteroscopy. All the patients were treated with double J tube under ureteroscope while anti-infective therapy was given. If the site of some stones was better and the infection was not further aggravated during operation, the patients with stable vital signs were treated with holmium laser lithotripsy at one stage, and the patients were treated with holmium laser lithotripsy. The therapeutic effect and safety were observed. Results in 6 cases of ureteral calculi complicated with acute pyelitis during pregnancy, the body temperature returned to normal within 1 ~ 4 days and the white blood cell count returned to normal within 3 ~ 6 days after ureteroscopy with double J tube placement, which was compared with that before catheterization. The levels of C- reactive protein and procalcitonin in all patients were significantly decreased after catheterization (P0.05) 5 patients had septic shock before operation and were transferred to ICU in time for anti-infection therapy. After infection control, ureteral catheterization or holmium laser lithotripsy was successfully performed to relieve the etiology of acute pyelitis; all patients were removed after 2 to 8 months of built-in double J tube; all patients were followed up until delivery. Among them, 4 cases were required to induce labor by themselves, and all the other cases were born smoothly, and no severe obstetric complications occurred. Conclusion it is safe and effective to place ureteral double J tube in pregnancy ureteral calculi complicated with acute renal pelvis infection. Early placement of ureteral double J tube can create favorable conditions for the next step of ureteral calculi treatment.
【作者單位】： 余姚市人民醫(yī)院泌尿外科;余姚市人民醫(yī)院婦產(chǎn)科;寧波大學(xué)醫(yī)學(xué)院;
【基金】：浙江省中西醫(yī)結(jié)合學(xué)會(huì)科研基金項(xiàng)目(2013LYSX004)
【分類(lèi)號(hào)】：R714.258

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