妊娠输尿管镜钬激光碎石术对围手术期早孕两项和妊娠结局的影响
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摘要
目的探讨经尿道输尿管镜下钬激光碎石术对妊娠患者合并输尿管结石围手术期早孕两项和妊娠结局的影响。方法回顾性分析2012年1月至2017年12月在中山大学附属第三医院和东莞康华医院就诊的反复性肾绞痛早期妊娠患者27例,年龄20～39(29.1±5.6)岁,初诊平均妊娠8～13(11.8±3.2)周。结石大小6～16(10.0±5.6)mm,单侧输尿管结石25例,双侧输尿管结石2例,合并有肾结石4例。保守治疗无效,在硬膜外麻醉成功后行经尿道输尿管镜下钬激光碎石术,术后均留置双J管。结果手术均取得成功,碎石成功率100%,手术时间5～36(14.9±10.5)min。术后症状均明显缓解,无妇产科及泌尿外科相关手术并发性。术晨、术后第1天、第3天检测血清孕酮值分别为(26.2±5.8)、(25.7±8.5)、(26.3±7.5)ng/mL,人绒毛膜促性腺激素水平分别为(96 322.5±2 645.6)、(104 592.1±2 007.3)、(106 798.3±2 374.7)mIU/mL,手术前后差异无统计学意义(均P> 0.05)。术中胎心率133～170(146.4±24.7)次/min;所有患者均顺利度过妊娠及围产期,胎儿正常。结论妊娠因结石导致的顽固性肾绞痛经保守治疗无效的患者应主动接受进一步治疗,经尿道输尿管镜下钬激光碎石术对此类患者围手术期早孕两项和妊娠结局均无影响,是安全有效的治疗方法之一。
Objective The study was performed to investigate the influence of ureteroscopic holmium:YAG laser lithotripsy(UHYLL)on perioperative human chorionic gonadotropin(HCG)and progesterone levelsand pregnancy outcome in pregnancy. Methods A retrospective analysis was performed on 27 patients referred totwo hospitals between January 2012 to December 2017 suffering repeatability renal colic during their early pregnancy.The median age of patients was 29(20 ～ 39)years,and the median gestational duration was 11.7(8 ～ 13)weeks.Median stone size was 10(6 ～ 16)mm. 25 patients with unilateral ureteral calculus(92.6%)and 2 patientswith bilateral ureteral calculus(7.4%)were selected. Among them,4 patients were also suffering renal calculus(14.8%). UHYLL was proceeded in all patients when conservative treatment was noneffective. Results The suc-cessful rate of lithotripsy reached 100% and the median operation time was 15(5 ～ 36)min and 146(133 ～ 170)beats/min. No complications related to operation occurred. Serum progesterone and HCG in operational morning,the first and third postoperative day were(26.2 ± 5.8)versus(25.7 ± 8.5)versus(26.3 ± 7.5)ng/mL and(96322.5 ± 2 645.6)versus(104 592.1 ± 2 007.3)versus(106 798.3 ± 2 374.7)m IU/mL,respectively. The differ-ence between preoperative and postoperative data was not statistically significant(P > 0.05). All patients had nor-mal gestational and perinatal periods without any negative consequences. Conclusions UHYLL should be recom-mended to patients with refractory renal colic caused by ureteral calculus during early pregnancy when conservativetreatment is invalid as it is a safe and effective method causing no influence on perioperative HCG and progesteronelevels and pregnancy outcome.
Objective The study was performed to investigate the influence of ureteroscopic holmium:YAG laser lithotripsy(UHYLL)on perioperative human chorionic gonadotropin(HCG)and progesterone levelsand pregnancy outcome in pregnancy. Methods A retrospective analysis was performed on 27 patients referred totwo hospitals between January 2012 to December 2017 suffering repeatability renal colic during their early pregnancy.The median age of patients was 29(20 ～ 39)years,and the median gestational duration was 11.7(8 ～ 13)weeks.Median stone size was 10(6 ～ 16)mm. 25 patients with unilateral ureteral calculus(92.6%)and 2 patientswith bilateral ureteral calculus(7.4%)were selected. Among them,4 patients were also suffering renal calculus(14.8%). UHYLL was proceeded in all patients when conservative treatment was noneffective. Results The suc-cessful rate of lithotripsy reached 100% and the median operation time was 15(5 ～ 36)min and 146(133 ～ 170)beats/min. No complications related to operation occurred. Serum progesterone and HCG in operational morning,the first and third postoperative day were(26.2 ± 5.8)versus(25.7 ± 8.5)versus(26.3 ± 7.5)ng/mL and(96322.5 ± 2 645.6)versus(104 592.1 ± 2 007.3)versus(106 798.3 ± 2 374.7)m IU/mL,respectively. The differ-ence between preoperative and postoperative data was not statistically significant(P > 0.05). All patients had nor-mal gestational and perinatal periods without any negative consequences. Conclusions UHYLL should be recom-mended to patients with refractory renal colic caused by ureteral calculus during early pregnancy when conservativetreatment is invalid as it is a safe and effective method causing no influence on perioperative HCG and progesteronelevels and pregnancy outcome.
引文
[1]THOMAS A A,THOMAS A Z,CAMPBELL S C,et al.Urologic emergencies in pregnancy[J].Urology,2010,76(2):453-460.
[2]ZIEMBA J B,STERLING M E,MUCKSAVAGE P.Care of acute renal colic:a survey of emergency medicine physicians[J].Can J Urol,2016,23(4):8368-8374.
[3]陈晓东.108例妊娠合并输尿管结石治疗效果的多因素分析[D].南方医科大学,2016.
[4]STOTHERS L,LEE L M.Renal colic in pregnancy[J].J Urol,1992,148(5):1383-1387.
[5]GEORGESCU D,MULTESCU R,GEAVLETE B,et al.Ureteroscopy-first-line treatment alternative in ureteral calculi during pregnancy?[J].Chirurgia(Bucur),2014,109(2):229-232.
[6]AKPINAR H,TüFEK I,ALICI B,et al.Ureteroscopy and holmium laser lithotripsy in pregnancy:stents must be used postoperatively[J].J Endourol,2006,20(2):107-110.
[7]SEMINS M J,MATLAGA B R.Kidney stones and pregnancy[J].Adv Chronic Kidney Dis,2013,20(3):260-264.
[8]ROSS A E,HANDA S,LINGEMAN J E,et al.Kidney stones during pregnancy:an investigation into stone composition[J].Urol Res,2008,36(2):99-102.
[9]BOZKURT Y,SOYLEMEZ H,ATAR M,et al.Effectiveness and safety of ureteroscopy in pregnant women:a comparative study[J].Urolithiasis,2013,41(1):37-42.
[10]孙华宾,刘雅峰,刘燕,等.腔内微创技术治疗妊娠并发输尿管结石[J/CD].中华腔镜泌尿外科杂志:电子版,2010,4(3):227-229.
[11]EVANS H J,WOLLIN T A.The management of urinary calculi in pregnancy[J].Curr Opin Urol,2001,11(4):379-384.
[12]钟甲萍,李庆梅,肖相云.探讨初次妊娠早期血清孕酮浓度与妊娠结局的关系[J].临床合理用药杂志,2013,6(1):88.
[13]VAN TROMMEL N E,SWEEP F C,SCHIJF C P,et al.Diagnosis of hydatidiform mole and persistent trophoblastic disease:diagnostic accuracy of total human chorionic gonadotropin(hCG),free hCG{alpha}-and{beta}-subunits,and their ratios[J].Eur J Endocrinol,2005,153(4):565-575.
[14]ILLESCAS T,FERNáNDEZ C,ORTEGA D,et al.Influence of gravidity and foetal gender on the value of screening variables in the first trimester of pregnancy[J].Eur J Obstet Gynecol Reprod Biol,2013,167(1):14-17.
[15]ARDAWI M S,NASRAT H A,ROUZI A A,et al.Maternal serum free-beta-chorionic gonadotrophin,pregnancy-associated plasma protein-A and fetal nuchal translucency thickness at 10-13(+6)weeks in relation to co-variables in pregnant Saudi women[J].Prenat Diagn,2007,27(4):303-311.
[16]DUAN L,YAN D,ZENG W,et al.Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage[J].Arch Gynecol Obstet,2011,283(3):431-435.
[17]贺彤.动态血清孕酮及β-人绒毛膜促性腺激素对早期异常妊娠的临床意义探讨[J].实用预防医学,2013,20(9):1134-1135.
[18]臧文红,杜洪灵.血清孕酮和β-人绒毛膜促性腺激素联合检测对早期妊娠结局的预测意义[J].中国临床医学,2013,20(5):680-681.
[19]BAYAR G,BOZKURT Y,ACINIKLI H,et al.Which treatment method should be used in pregnant patients with ureteral calculi?Two center comparative study[J].Arch Esp Urol,2015,68(4):435-440.
[20]GRANATA A,ANDRULLI S,BIGI M Q,et al.Predictive role of duplex Doppler ultrasonography in the diagnosis of acute renal obstruction in patients with unilateral renal colic[J].Clin Nephrol,2009,71(6):680-686.
[21]徐遵礼,石格荣,窦维龙,等.两种腔镜术式治疗妊娠合并输尿管结石的比较[J/D].中华腔镜泌尿外科杂志:电子版,2015,9(6):399-402.
[22]TRAVASSOS M,AMSELEM I,FILHO N S,et al.Ureteroscopy in pregnant women for ureteral stone[J].J Endourol,2009,23(3):405-407.
[23]ADANUR S,ZIYPAK T,BEDIR F,et al.Ureteroscopy and holmium laser lithotripsy:is this procedure safe in pregnant women with ureteral stones at different locations?[J].Arch Ital Urol Androl,2014,86(2):86-89.
[24]LEMOS G C,EL HAYEK O R,APEZZATO M.Rigid ureteroscopy for diagnosis and treatment of ureteral calculi during pregnancy[J].Int Braz J Urol,2002,28(4):311-315.
[25]ISEN K,HATIPOGLU N K,DEDEOGLU S,et al.Experience with the diagnosis and management of symptomatic ureteric stones during pregnancy[J].Urology,2012,79(3):508-512.
[26]RIVERA M E,MCALVANY K L,BRINTON T S,et al.Anesthetic exposure in the treatment of symptomatic urinary calculi in pregnant women[J].Urology,2014,84(6):1275-1278.2018-05-28
[2]ZIEMBA J B,STERLING M E,MUCKSAVAGE P.Care of acute renal colic:a survey of emergency medicine physicians[J].Can J Urol,2016,23(4):8368-8374.
[3]陈晓东.108例妊娠合并输尿管结石治疗效果的多因素分析[D].南方医科大学,2016.
[4]STOTHERS L,LEE L M.Renal colic in pregnancy[J].J Urol,1992,148(5):1383-1387.
[5]GEORGESCU D,MULTESCU R,GEAVLETE B,et al.Ureteroscopy-first-line treatment alternative in ureteral calculi during pregnancy?[J].Chirurgia(Bucur),2014,109(2):229-232.
[6]AKPINAR H,TüFEK I,ALICI B,et al.Ureteroscopy and holmium laser lithotripsy in pregnancy:stents must be used postoperatively[J].J Endourol,2006,20(2):107-110.
[7]SEMINS M J,MATLAGA B R.Kidney stones and pregnancy[J].Adv Chronic Kidney Dis,2013,20(3):260-264.
[8]ROSS A E,HANDA S,LINGEMAN J E,et al.Kidney stones during pregnancy:an investigation into stone composition[J].Urol Res,2008,36(2):99-102.
[9]BOZKURT Y,SOYLEMEZ H,ATAR M,et al.Effectiveness and safety of ureteroscopy in pregnant women:a comparative study[J].Urolithiasis,2013,41(1):37-42.
[10]孙华宾,刘雅峰,刘燕,等.腔内微创技术治疗妊娠并发输尿管结石[J/CD].中华腔镜泌尿外科杂志:电子版,2010,4(3):227-229.
[11]EVANS H J,WOLLIN T A.The management of urinary calculi in pregnancy[J].Curr Opin Urol,2001,11(4):379-384.
[12]钟甲萍,李庆梅,肖相云.探讨初次妊娠早期血清孕酮浓度与妊娠结局的关系[J].临床合理用药杂志,2013,6(1):88.
[13]VAN TROMMEL N E,SWEEP F C,SCHIJF C P,et al.Diagnosis of hydatidiform mole and persistent trophoblastic disease:diagnostic accuracy of total human chorionic gonadotropin(hCG),free hCG{alpha}-and{beta}-subunits,and their ratios[J].Eur J Endocrinol,2005,153(4):565-575.
[14]ILLESCAS T,FERNáNDEZ C,ORTEGA D,et al.Influence of gravidity and foetal gender on the value of screening variables in the first trimester of pregnancy[J].Eur J Obstet Gynecol Reprod Biol,2013,167(1):14-17.
[15]ARDAWI M S,NASRAT H A,ROUZI A A,et al.Maternal serum free-beta-chorionic gonadotrophin,pregnancy-associated plasma protein-A and fetal nuchal translucency thickness at 10-13(+6)weeks in relation to co-variables in pregnant Saudi women[J].Prenat Diagn,2007,27(4):303-311.
[16]DUAN L,YAN D,ZENG W,et al.Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage[J].Arch Gynecol Obstet,2011,283(3):431-435.
[17]贺彤.动态血清孕酮及β-人绒毛膜促性腺激素对早期异常妊娠的临床意义探讨[J].实用预防医学,2013,20(9):1134-1135.
[18]臧文红,杜洪灵.血清孕酮和β-人绒毛膜促性腺激素联合检测对早期妊娠结局的预测意义[J].中国临床医学,2013,20(5):680-681.
[19]BAYAR G,BOZKURT Y,ACINIKLI H,et al.Which treatment method should be used in pregnant patients with ureteral calculi?Two center comparative study[J].Arch Esp Urol,2015,68(4):435-440.
[20]GRANATA A,ANDRULLI S,BIGI M Q,et al.Predictive role of duplex Doppler ultrasonography in the diagnosis of acute renal obstruction in patients with unilateral renal colic[J].Clin Nephrol,2009,71(6):680-686.
[21]徐遵礼,石格荣,窦维龙,等.两种腔镜术式治疗妊娠合并输尿管结石的比较[J/D].中华腔镜泌尿外科杂志:电子版,2015,9(6):399-402.
[22]TRAVASSOS M,AMSELEM I,FILHO N S,et al.Ureteroscopy in pregnant women for ureteral stone[J].J Endourol,2009,23(3):405-407.
[23]ADANUR S,ZIYPAK T,BEDIR F,et al.Ureteroscopy and holmium laser lithotripsy:is this procedure safe in pregnant women with ureteral stones at different locations?[J].Arch Ital Urol Androl,2014,86(2):86-89.
[24]LEMOS G C,EL HAYEK O R,APEZZATO M.Rigid ureteroscopy for diagnosis and treatment of ureteral calculi during pregnancy[J].Int Braz J Urol,2002,28(4):311-315.
[25]ISEN K,HATIPOGLU N K,DEDEOGLU S,et al.Experience with the diagnosis and management of symptomatic ureteric stones during pregnancy[J].Urology,2012,79(3):508-512.
[26]RIVERA M E,MCALVANY K L,BRINTON T S,et al.Anesthetic exposure in the treatment of symptomatic urinary calculi in pregnant women[J].Urology,2014,84(6):1275-1278.2018-05-28
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