Institute of Clinical Anatomy, Southern Medical University, Guangzhou, Guangdong, China; Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China.
Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China.
Urology. 2014 Apr;83(4):745-9. doi: 10.1016/j.urology.2013.11.031. Epub 2014 Feb 6.
To review our experience with invasive management of proximal ureteral calculi during pregnancy when conservative treatment fails.
From February 2006 to September 2012, a total of 87 pregnant women received invasive management for proximal ureteral calculi in our center. Invasive management included the following: double-J stent insertion, percutaneous nephrostomy (PCN), and ureteroscopic lithotripsy (URSL). The medical records of these patients were reviewed retrospectively.
Of the 87 patients, 4 patients received PCN; 19 patients received cystoscopic double-J stent insertion, whereas 2 patients (10.5%) failed in guide wire inserting and switched to ureteroscopic aid; a total of 64 patients received URSL with holmium laser, in which 52 patients (81.2%) had complete fragmentation of calculi; in 9 patients (14.1%), stone fragments retrograde migrated to the renal pelvis; in 3 patients (4.7%), the stone could not be reached because of serious ureteral tortuosity. One patient (1.6%) patient had a threatened abortion, but this problem was resolved immediately using conservative treatment. All patients completed the full term of pregnancy, and no serious obstetric or urologic complications were observed.
For pregnant patients with proximal ureteral calculi, double-J stent insertion, PCN, and URSL all are effective and safe options when conservative treatment fails. They should be chosen on the basis of different patient's condition. However, patient's postoperative tolerance was poor for double-J stent insertion and PCN; URSL (especially with holmium laser lithotripsy) is more effective and should be considered as the preferred choice.
回顾我们在保守治疗失败时对妊娠合并近端输尿管结石进行有创治疗的经验。
2006 年 2 月至 2012 年 9 月，我院共有 87 例妊娠合并近端输尿管结石患者接受有创治疗。有创治疗包括双 J 管置入、经皮肾穿刺造瘘术（PCN）和输尿管镜碎石术（URSL）。回顾性分析这些患者的病历。
87 例患者中，4 例行 PCN；19 例行膀胱镜双 J 管置入术，其中 2 例（10.5%）导丝插入失败，改行输尿管镜辅助；64 例行 URSL 联合钬激光碎石术，其中 52 例（81.2%）结石完全粉碎；9 例（14.1%）结石碎片逆行迁移至肾盂；3 例（4.7%）因输尿管严重迂曲而无法触及结石。1 例（1.6%）患者发生先兆流产，但经保守治疗后很快得到缓解。所有患者均完成足月妊娠，未发生严重产科或泌尿科并发症。
对于妊娠合并近端输尿管结石患者，当保守治疗失败时，双 J 管置入、PCN 和 URSL 均为有效且安全的选择。应根据患者的具体情况选择。然而，双 J 管置入和 PCN 患者术后耐受性差；URSL（尤其是钬激光碎石术）更为有效，应作为首选。
