發(fā)布時間：2018-02-28 01:01

  本文關(guān)鍵詞： 妊娠 輸尿管結(jié)石 診斷 治療　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)石的臨床特點及診療措施。方法:通過查閱電子病歷,回顧性分析2010年1月至2015年12月遵義醫(yī)學(xué)院附屬醫(yī)院收治的17780例孕婦病例資料,其中自然妊娠15280例,合并輸尿管結(jié)石53例,平均年齡(25±4)歲;輔助生殖2500例,合并輸尿管結(jié)石2例,平均年齡(32±5)歲。記錄合并輸尿管結(jié)石孕婦的年齡、文化程度、孕期、泌尿系感染、臨床癥狀、治療方式、孕前腹部或泌尿系超聲檢查等觀察指標;統(tǒng)計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,采用卡方檢驗,比較其在自然妊娠與輔助生殖孕婦有無顯著性差異;分析妊娠期輸尿管結(jié)石與孕婦年齡、文化、孕周的關(guān)系,以及發(fā)病期的臨床特點、超聲檢查的應(yīng)用價值;比較不同治療方式對孕期輸尿管結(jié)石臨床癥狀控制的效果,歸納妊娠期輸尿管結(jié)石的有效治療方案。結(jié)果:17780例孕婦中除輔助生殖的2500例在孕前檢查中接受過一次以上腹部或泌尿系超聲檢查外,其余孕婦均無超聲檢查;妊娠期輸尿管結(jié)石發(fā)病率在輔助生殖與自然妊娠組分別為0.08%(2/2500)、0.35%(53/15280),兩組在孕前泌尿系超聲應(yīng)用率、妊娠期輸尿管結(jié)石發(fā)病率方面存在顯著性差異(P0.05)。自然妊娠組年齡26歲段,隨孕育年齡的降低孕期輸尿管結(jié)石發(fā)病率增高,而年齡35歲段,隨孕育年齡增加發(fā)病率逐漸增高;妊娠輸尿管結(jié)石在不同孕期間的發(fā)病率也存在差異,妊娠18~28周者發(fā)病率較高,約占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較高,占67%(36/53);結(jié)石合并泌尿系感染者89.09%(49/55),其中并發(fā)急性腎盂腎炎、高熱34.54%(19/55),少數(shù)發(fā)展到感染性休克3.63%(2/55)。55例妊娠期輸尿管結(jié)石孕婦中36例經(jīng)單純非手術(shù)治療后癥狀持續(xù)控制,順利分娩,19例經(jīng)非手術(shù)無效后接受手術(shù)治療,以局部麻醉下輸尿管內(nèi)支架植入為主,約占68.42%(13/19),術(shù)后癥狀均持續(xù)緩解到產(chǎn)后。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。結(jié)論:妊娠期輸尿管結(jié)石總體發(fā)病率較低,但對母胎影響較大,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)病率相對較高,其發(fā)病時間多集中于妊娠中期,多伴泌尿系感染。妊娠期輸尿管結(jié)石多數(shù)可通過非手術(shù)治療控制癥狀,治療效果較差者,局部麻醉下行輸尿管內(nèi)支架植入術(shù)可視為優(yōu)選方案,能夠有效控制癥狀。
[Abstract]:Objective: to investigate the clinical characteristics and diagnosis and treatment of ureteral calculi during pregnancy. Methods: through the review of electronic medical records, the data of 17780 cases of pregnant women admitted to the affiliated Hospital of Zunyi Medical College from January 2010 to December 2015 were analyzed retrospectively. There were 15280 cases of natural pregnancy, 53 cases of ureteral calculi with mean age of 25 鹵4 years, 2 cases of assisted reproduction and 2 cases of ureteral calculi, with an average age of 32 鹵5 years. The age, education and pregnancy of pregnant women with ureteral calculi were recorded. Urinary tract infection, clinical symptoms, treatment methods, pre-pregnancy abdominal or urinary system ultrasound examination and other observation indicators, statistics of pre-pregnancy urinary tract ultrasound examination rate, gestational ureteral calculi incidence, chi-square test, The relationship between ureteral calculi and pregnant women's age, culture, gestational age, clinical characteristics and the value of ultrasound examination were analyzed. To compare the effect of different treatment methods on the clinical symptom control of ureteral calculi during pregnancy. Results among 17 780 pregnant women, 2 500 cases of assisted reproduction underwent more than one ultrasound examination of abdomen or urinary system before pregnancy, all the other pregnant women were not examined by ultrasound. The incidence of ureterolithiasis during pregnancy was 0.08 / 2500 / 0.3553 / 15280 in assisted reproduction group and natural pregnancy group, respectively. There was a significant difference between the two groups in prepregnancy urinary tract ultrasound application rate and pregnancy ureteral stone incidence rate (P 0.05). The age of natural pregnancy group was 26 years old. The incidence of ureteral calculi increased with the decrease of gestational age, and the incidence of ureteral calculi increased gradually with gestational age of 35 years old, and the incidence of ureteral calculi in different pregnancy periods was also different, and the incidence of ureteral calculi was higher in 1828 weeks gestation. About 76% 40 / 53%; pregnant women have different education levels, and the proportion of ureteral calculi is also different. Those with less than high school education are relatively high, accounting for 6736 / 53%; stones complicated with urinary tract infections 89.09 / 55%, among them acute pyelonephritis. A small number of pregnant women with high fever 34.54 / 55 had septic shock of 3.63 / 55. Of the 55 pregnant women with ureteral calculi during pregnancy, 36 had their symptoms under continuous control after non-surgical treatment alone, and 19 patients with successful delivery received surgical treatment after non-operative failure. Ureteral stents were mainly implanted under local anesthesia. The postoperative symptoms were relieved to the postpartum. There was significant difference between the non-operative treatment group and the surgical treatment group in the clinical symptom continuous control and the recurrence rate (P 0.05), and the curative effect in the non-operation group was lower than that in the operation group. The overall incidence of urethral calculi was low. The incidence of ureteral calculi was relatively high in pregnant women younger than 26 years old and more than 35 years old, and the incidence of ureteral calculi in pregnancy was relatively high, and the incidence of ureteral calculi in pregnancy was relatively high. Most of the ureteral calculi during pregnancy can be controlled by non-surgical treatment. If the treatment effect is poor, the ureteral stent implantation under local anesthesia can be regarded as the optimal scheme. Can effectively control symptoms.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.258

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