王明镑　刘榕臻

【摘要】 目的：探索妊娠期合并肾积水伴或不伴感染的原因和治疗方法。方法：58例娠合并肾积水患者中33例采用内科保守治疗，25例采用输尿管镜下输尿管置管，其中2例采用输尿管镜术+气压弹道碎石的方法治疗。结果：58例中肾绞痛症状均得到缓解，肾盂积水不同程度减少，肾盂感染缓解，治疗后顺利完成妊娠。结论：轻度和中度妊娠期肾积水合并肾绞痛、尿路感染者经保守治疗可以获得缓解。治疗后患者疼痛程度明显下降，差异有统计学意义（P<0.05）。妊娠合并肾绞痛反复发作、伴有输尿管结石或重度肾积水的患者采用经输尿管镜输尿管置双J管引流术效果良好；输尿管结石妊娠患者输尿管镜弹道碎石效果可靠，生理干扰少，损伤小，对胎儿是比较安全的。

【关键词】 妊娠；肾积水；输尿管结石；输尿管镜术

【Abstract】Objective： To explore the pregnancy complicated with hydronephrosis with or without cause and treatment of infection. Methods： 58 cases of pregnancy complicated with hydronephrosis in 33 cases with conservative treatment in the Department of internal medicine， 25 cases by Ureteroscope ureter catheter， using the method of ureteroscopy pneumatic lithotripsy in the treatment of + 2 cases. Results： in 58 cases of renal colic symptoms were relieved in different degree reduction， hydronephrosis， renal pelvis infections treatment remission， after the successful completion of pregnancy. Conclusion： mild and moderate hydronephrosis of pregnancy patients with renal colic， urinary tract infection after conservative treatment can obtain remission. Pregnancy associated with recurrent renal colic， associated with ureteral calculi or severe hydronephrosis were treated by ureteroscopy placement of double J ureteral catheter drainage effect is good； ureteral calculi patients with pregnancy ureteroscope reliable effect， less physical interference， the damage is small， is relatively safe for the fetus.

【key words 】pregnancy； hydronephrosis； ureteral calculi； Ureteroscopy

【中图分类号】R722.12 【文献标识码】B【文章编号】1004-4949（2015）02-0004-01

我科自2008年以来开展输尿管镜技术后收治58例妊娠期肾积水伴或不伴感染的患者，分别采用保守治疗，置输尿管支架管引流和输尿管镜术腔内碎石等方法治疗，取得良好疗效，现报告如下

l 资料与方法

1.1 临床资料 ：本组58例，年龄20～38岁，平均28.5岁。妊娠12～38周，平均24周，均为单胎。肾积水程度彩超肾盂分离分级（1）：轻度（1.2～2.0 cm）12例；中度（2.1-3.0 cm，肾皮质輕度薄）20例；重度（>3cm，肾皮质明显变薄）26例，其中3例>5 cm；肾积水右侧33例，左侧15例，双侧10例；就诊原因：肾区疼痛41例，体检B超发现肾积水17例；并发肾、输尿管结石5例，尿细菌培养阳性22例，肾盂积脓2例，伴发热15例，血尿素氮和肌酐不同程度升高4例。

1.2 治疗方法：53例未伴有结石患者均先给予内科保守治疗，即健侧卧位加解痉止痛药物（黄体酮20 mg，肌注，2次/d；间苯三酚 40-80mg，静滴，1次/d）治疗；发热和尿细菌培养阳性者给予敏感抗生素治疗。20例因顽固性肾绞痛发作选择输尿管镜下置J管引流；重度……