妊娠期输尿管结石探讨
本文选题:妊娠 切入点:输尿管结石 出处:《遵义医学院》2017年硕士论文 论文类型:学位论文
【摘要】:目的:探讨妊娠期输尿管结石的临床特点及诊疗措施。方法:通过查阅电子病历,收集2010年1月至2015年12月遵义医学院附属医院收治的孕妇病例资料共17780例,其中自然妊娠15280例,平均年龄(25±4)岁,辅助生殖2500例,平均年龄(32±5)岁,统计孕前泌尿系超声检查应用率、妊娠期输尿管结石发病率,比较其在自然妊娠组与辅助生殖组孕妇有无显著性差异;记录妊娠期输尿管结石孕妇的年龄、文化程度、孕期、泌尿系感染情况、临床症状、辅助检查、治疗方式等观察指标,分析妊娠期输尿管结石与年龄、文化、发病时间的关系,总结妊娠期输尿管结石发病的临床特点及治疗措施,追踪其治疗与转归情况,比较不同治疗方式对孕期输尿管结石临床症状控制的效果。结果:辅助生殖组孕前均有泌尿系超声检查,自然妊娠组未做,妊娠期输尿管结石发病率分别为0.08%(2/2500)、0.35%(53/15280),两组孕前泌尿系超声应用率、妊娠期输尿管结石发病率比较均有显著性差异(P0.05)。自然妊娠组26岁年龄段孕妇,随年龄降低孕期输尿管结石发病率增高,35岁年龄段孕妇,随年龄增加其发病率逐渐增高;不同孕期输尿管结石发病存在差异,妊娠18~28周发病者最多,占76%(40/53);孕妇文化程度不同,发生输尿管结石的比例也有不同,高中以下文化程度者相对较高,占67%(36/53)。泌尿系感染者占89.09%(49/55),其中34.54%(19/55)并发急性肾盂肾炎,3.63%(2/55)感染较重出现感染性休克。非手术治疗组与手术治疗组在临床症状持续控制与再发生率间存在显著性差异(P0.05),非手术组疗效低于手术组;手术治疗方式以局部麻醉下输尿管内支架植入为主,约占68.42%(13/19)。结论:妊娠期输尿管结石总体发病率较低,但对母胎影响较大,孕前泌尿系超声筛查有助于降低其发病率;小于26岁与大于35岁年龄段孕妇、低文化程度孕妇,妊娠期输尿管结石发病率相对较高,其发病时间多集中于妊娠中期,多伴泌尿系感染;非手术治疗效果差,局部麻醉下行输尿管内支架植入术可以有效控制症状,操作简便、对母胎影响小、医患均较容易接受。
[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 卤4 years, 2 500 cases of assisted reproduction, and mean age of 32 卤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.
【学位授予单位】:遵义医学院
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R714.258
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