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題名 | Management of Symptomatic Urolithiasis during Pregnancy=懷孕時有症狀的泌尿道結石治療 |
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作者 | 阮雍順; 吳文正; 莊淑棉; 王起杰; 沈榮宗; 龍震宇; 黃俊雄; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 23:5 2007.05[民96.05] |
頁次 | 頁241-246 |
分類號 | 416.274 |
關鍵詞 | 懷孕; 輸尿管鏡碎石; 尿路結石; Pregnancy; Ureteroscopic lithotripsy; Urolithiasis; |
語文 | 英文(English) |
中文摘要 | 懷孕時合併尿路結石,不只對於診斷是相當大的挑戰,在治療上也是個難題。在這個回溯性的研究,我們提出對於診斷與治療懷孕時合併尿路結石的經驗。從 1999 年至 2004 年,一共有 18 位懷孕婦女因為尿路結石而在高雄市立小港醫院泌尿科接受治療。懷孕時有症狀的結石發生率為 0.35%;在 20 個結石中,右側的有 9 個,左側的有 11 個,其中有兩位同時有雙側的結石。大部分診斷出結石時都在妊娠的第三期 (55.5%),腹痛 (94.4%) 是最常見的症狀。十位患者以保守性處置而成功的等到生產後再做確切的治療,有四位患者因持續疼痛而放置雙 J 導管,有三位患者因持續疼痛且放置雙 J 導管失敗而接受輸尿管鏡取石術,一位患者則因持續疼痛以及腎孟積膿而接受經皮腎造廔管引流。利用超音波來診斷懷孕時合併尿路結石是相當合理且準確的方法。輸尿管鏡取石手術對於保守性處置失敗且需要確切泌尿道處置的患者提供另一個選擇。 |
英文摘要 | Urinary calculi during pregnancy present not only a diagnostic challenge but also a management dilemma. In this retrospective study, we describe our experience with diagnosis and management of symptomatic urolithiasis in pregnant women. A total of 18 pregnant women were treated for urolithiasis at the Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, between 1999 and 2004. The incidence of symptomatic urolithiasis during pregnancy was 0.35%. Of the 20 stones found, nine were on the right side and 11 were on the left, and two patients had bilateral urinary stones. Most urolithiasis cases during pregnancy (55.5%) occurred in the third trimester. Flank pain (94.4%) was the most common clinical presentation. Conservative management was successful in 10 patients until the end of pregnancy and then definite treatment was performed. In four patients, a double-J stent was inserted successfully for persistent pain. In three cases with persistent pain, failure of double-J stent placement was treated with ureteroscopic lithotripsy under epidural anesthesia. One patient received percutaneous nephrostomy for persistent renal colic and pyonephrosis. Ultrasonographic evaluation of pregnant women with suspected renal colic is a reasonable diagnostic procedure. Ureteroscopy is another choice when conservative treatment fails. |
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