摘要:妊娠期输尿管结石可能诱发急性肾绞痛、泌尿系感染甚至脓毒血症,诊疗时不仅需要保证孕妇的生命安 全,还要考虑诊治过程对胎儿健康的影响,需要泌尿外科、产科、放射科、麻醉科多学科协作,相当谨慎和棘 手,本文将国内外学者在妊娠期输尿管结石的诊断进展进行综述。
暂无相关信息!
[1] BLANCO L T,SOCARRAS M R,MONTERO R F,et al. Renal colic during pregnancy: Diagnostic and therapeutic aspects. Literature review [J]. Cent European J Urol,2017, 70(1):93-100
[2] KS A,EMS A,SL A,et al. Urinary stone disease in pregnancy: current management practices in a large National cohort [J]. Urology,2020,142(70):60-64
[3] HOSSEINI M M,HASSANPOUR A,ESLAHI A,et al. Percutaneous nephrolithotomy during early pregnancy in urgent situations: is it feasible and safe [J]. Urol J,2017,14 (6):5034-5037
[4] TÜRK C,PETŘÍK A,SARICA K,et al. EUA guidelines on diagnosis and conservative management of urolithiasis [J]. Eur Urol,2016,69(3):468-474
[5] GOLDFARB D S,AVERY A R,BEARA- LASIC L,et al. A twin study of genetic influences on nephrolithiasis in women and men [J]. Kidney INT REP,2018,4(4):535-540
[6] VALOVSKA M,PAIS V M. Contemporary best practice urolithiasis in pregnancy [J]. Ther Adv Urol,2018,10(4): 127-138
[7] BJAZEVIC J,RAZVI H. Stones in pregnancy and pediatrics [J]. Asian J Urol,2018,5(4):223-234
[8] DUVDEVANI M,SFOUNGARISTOS S,BENSALAH K, et al. Stones in special situations [J]. World J Urol,2017,35 (9):1381-1393
[9] BURGESS KL,GETTMAN MT,RANGEL LJ,et al. Diagnosis of urolithiasis and rate of spontaneous passage during pregnancy [J]. J Urol,2011,186(6):2280-2284
[10] Hadjipavlou M,Tasleem A,Santos FD,et al. Urolithiasis in pregnancy [J]. J CLIN UROL,2017,10(2):93-104
[11] N'GAMBA M,LEBDAI S,HASTING C,et al. Acute renal colic during pregnancy: management and predictive factors [J]. Can J UROL,2015,22(2):7732-7738
[12] HERTZBERG B S,CARROLL B A,BOWIE J D,et al. Doppler US assessment of maternal kidneys: analysis of intrarenal resistivity indexesin normal pregnancy and physiologic pelvicaliectasis [J]. Radiology,1993,186(3):689-692
[13] NURI BODAKCI M,KEMAL HATIPOGLU N,OZLER A,et al. Hydronephrosis during pregnancy: how to make a decision about the time of intervention? [J]. MED Glas(Zenica),2014,11(1):165-169
[14] 韩秋云,司玺玺.阴道超声探头经腹壁探查输尿管第二狭窄处结 石602例分析[J].河南职工医学院学报,2014,26(1):3
[15] LO T S,LONG C Y,LIN Y H,et al. Doppler ureteric jet in urogenital prolapse [J]. Int Urogynecol J,2012,23(1):49- 56
[16] 焦建伟,曲直,李钧,等.妊娠期泌尿系结石诊疗进展[J].中国医刊, 2020,55(1):4
[17] SOMANI B K,DELLIS A,LIATSIKOS E,et al. Review on diagnosis and management of urolithiasis in pregnancy: an ESUT practical guide for urologists [J]. World J Urol, 2017,35(5):1637-1649
[18] WHITE W M,ZITE N B,GASH J,et al. Low-dose computed tomography for the evaluation of flank pain in the pregnant population [J]. J Endourol,2007,21(11):1255-1260
[19] SEMINS M J,MATLAGA B R. Kidney stones and pregnancy [J]. Advances in Chronic Kidney Disease,2013,20(3): 260-264
[20] JORDAN D,GULANI V. Editorial on "ACR Guidance Document on MR Safe Practices: Updates and Critical Information 2019" [J]. J Magn Reson Imaging,2020,51(2): 339-340
[21] MASSELLI G,WESTON M,SPENCER J. The role of imaging in the diagnosis and management of renal stone disease in pregnancy [J]. Clin Radiol,2015,70(12):1462-1471
[22] ACOG Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation [J]. Obstet Gynecol,2017,130(2):e210
[23] SPENCER J A,CHAHAL R,KELLY A,et al. Evaluation of painful hydronephrosis in pregnancy: magnetic resonanceurographic patterns in physiological dilatation versus calculous obstruction [J]. J Urol,2004,171(1):256-260.
班自芹,刘璐,李斌. 妊娠期输尿管结石诊断进展[J]. 泌尿外科杂志(电子版),2022,14(1):66-68. DOI:10.3969/j.issn.1674-7410.2022.01.017.
暂无相关信息!
妊娠期泌尿系结石发生率为5/1 000~8/1 000[1- 2] 。 其中妊娠期输尿管结石可能诱发急性肾绞痛、泌尿 系感染甚至脓毒血症,引起子宫收缩、流产等并发 症,临床医生不仅需要保证孕妇的生命安全,还要 考虑诊治过程对胎儿健康的影响,相当谨慎和棘 手[3-4] 。本文将国内外学者在妊娠期输尿管结石的诊 断进展作一综述。
1 妊娠期易发泌尿系结石的原因
2 妊娠期输尿管结石的诊断
2.1 彩超
2.1.1 肾盂积水程度
2.1.2 肾动脉阻力指数变化
2.1.3 经阴道超声
2.2 CT
2.3 X线和静脉肾盂造影 (intravenous pyelography, IVP)
2.4 磁共振尿路造影 (magnetic resonance urography, MRU)
3 小结
3 小结
妊娠期合并输尿管结石可能导致孕妇及胎儿出 现严重并发症,多需临床医生尽快作出明确诊断与 处理。在诊治过程中,需要考虑对胎儿健康的影 响,无放射风险的彩超被公认为首选的检查方式, 必要时可结合经腹及经阴彩超来间接诊断。CT由于 存在放射性,鉴于我国目前医疗环境及医患关系的 复杂性,除非疾病严重影响患者生命安全,在优先 保证患者生命安全前提下,充分告知患者及家属可 能造成的后果,取得签字同意后方可进行该项检 查。MRU 没有电离辐射,已被证明是相对安全的, 可间接发现输尿管结石的证据。对妊娠合并输尿管 结石的患者,需要多学科协作才能准确地做出诊 断,并与患者及家属积极沟通,进行及时、有效的 治疗。
暂无相关信息!
暂无相关信息!