妊娠期输尿管结石55例临床分析

发布时间：2018-02-28 01:01

本文关键词： 妊娠输尿管结石诊断治疗　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,回顾性分析2010年1月至2015年12月遵义医学院附属医院收治的17780例孕妇病例资料,其中自然妊娠15280例,合并输尿管结石53例,平均年龄(25±4)岁;辅助生殖2500例,合并输尿管结石2例,平均年龄(32±5)岁。记录合并输尿管结石孕妇的年龄、文化程度、孕期、泌尿系感染、临床症状、治疗方式、孕前腹部或泌尿系超声检查等观察指标;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,采用卡方检验,比较其在自然妊娠与辅助生殖孕妇有无显著性差异;分析妊娠期输尿管结石与孕妇年龄、文化、孕周的关系,以及发病期的临床特点、超声检查的应用价值;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,归纳妊娠期输尿管结石的有效治疗方案。结果:17780例孕妇中除辅助生殖的2500例在孕前检查中接受过一次以上腹部或泌尿系超声检查外,其余孕妇均无超声检查;妊娠期输尿管结石发病率在辅助生殖与自然妊娠组分别为0.08%(2/2500)、0.35%(53/15280),两组在孕前泌尿系超声应用率、妊娠期输尿管结石发病率方面存在显著性差异(P0.05)。自然妊娠组年龄26岁段,随孕育年龄的降低孕期输尿管结石发病率增高,而年龄35岁段,随孕育年龄增加发病率逐渐增高;妊娠输尿管结石在不同孕期间的发病率也存在差异,妊娠18~28周者发病率较高,约占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);结石合并泌尿系感染者89.09%(49/55),其中并发急性肾盂肾炎、高热34.54%(19/55),少数发展到感染性休克3.63%(2/55)。55例妊娠期输尿管结石孕妇中36例经单纯非手术治疗后症状持续控制,顺利分娩,19例经非手术无效后接受手术治疗,以局部麻醉下输尿管内支架植入为主,约占68.42%(13/19),术后症状均持续缓解到产后。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。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。妊娠期输尿管结石多数可通过非手术治疗控制症状,治疗效果较差者,局部麻醉下行输尿管内支架植入术可视为优选方案,能够有效控制症状。
[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 卤4 years, 2 cases of assisted reproduction and 2 cases of ureteral calculi, with an average age of 32 卤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.
【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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