Guichard G, Fromajoux C, Cellarier D, Loock P-Y, Chabannes E, Bernardini S, Maillet R, Bittard H, Kleinclauss F
Service d'urologie, hôpital Saint-Jacques, CHU de Besançon, université de Franche-Comté, 2, place Saint-Jacques, 25000 Besançon, France.
Prog Urol. 2008 Jan;18(1):29-34. doi: 10.1016/j.purol.2007.11.001. Epub 2008 Mar 4.
Urinary stones are relatively frequent in pregnant women and raise specific diagnostic and therapeutic problems. The authors conducted a retrospective review of the management of this disease in their establishment.
Between January 1999 and December 2003, out of a total of 10,398 parturients, 48 pregnant women were hospitalised for renal colic, that is, incidence of 0.04%. The medical records of these patients were retrospectively reviewed and clinical, laboratory, treatment and outcome data were analysed.
Standard analgesic treatment, comprising paracetamol and an antispasmodic, achieved pain relief in 84% of cases. A concomitant short course of corticosteroid therapy in cases of renal colic refractory to standard treatment was effective in 71% of patients and allowed deferral of surgical management in five out of seven cases. A double J stent was placed in all patients requiring urinary diversion, followed by closer ultrasound and bacteriological monitoring throughout pregnancy. Only two patients required surgical management of their stone after delivery. The only obstetric event related to renal colic was induction of labour at term in two cases because of foetal distress.
The authors propose a two-stage management plan for renal colic in pregnant women resulting in a low maternal and foetal complication rate.
孕妇尿路结石相对常见，并引发特定的诊断和治疗问题。作者对其所在机构中该疾病的管理进行了回顾性研究。
1999年1月至2003年12月期间，在总共10398名产妇中，有48名孕妇因肾绞痛住院，发病率为0.04%。对这些患者的病历进行回顾性研究，并分析临床、实验室、治疗及预后数据。
标准镇痛治疗，包括对乙酰氨基酚和一种解痉药，在84%的病例中实现了疼痛缓解。对于标准治疗无效的肾绞痛病例，短期联合使用皮质类固醇治疗在71%的患者中有效，并使7例中的5例得以推迟手术治疗。对所有需要尿液改道的患者均放置了双J支架，随后在整个孕期进行更密切的超声和细菌学监测。仅2例患者在产后需要对结石进行手术治疗。与肾绞痛相关的唯一产科事件是2例因胎儿窘迫而在足月时引产。
作者提出了一种针对孕妇肾绞痛的两阶段管理方案，该方案导致母婴并发症发生率较低。
