Clinical characteristics and treatment methods for symptomatic hydronephrosis during pregnancy
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摘要:目的 分析妊娠期肾积水的临床特点以及不同治疗方式的效果。方法 本研究纳入89例因腰痛、发热或腹痛等原因就诊于甘肃省妇幼保健院生殖泌尿外科的妊娠期肾积水患者，根据治疗方式不同分为支架置入组和保守治疗组。比较2组年龄、住院时间、妊娠时期、合并疾病、治疗前后肾积水程度、血白细胞(WBC)计数等指标。结果 89例妊娠期肾积水患者中, 97.75%(87/89)的患者为轻中度肾积水, 69例(77.53%)为右侧(含双侧)肾积水, 85例(95.51%)为中晚期妊娠, 25例合并泌尿系结石(28.09%)。支架置入或保守治疗后, 所有患者临床症状均明显好转，无流产病例，其中33例(37.08%)肾积水完全缓解, 35例(39.33%)为轻度肾积水, 3例(3.37%)为中度肾积水。支架置入组孕妇平均年龄(25.60±4.92)岁，保守治疗组为(28.61±4.54)岁, 2组孕妇平均年龄比较，差异有统计学意义(P<0.05); 支架置入组位住院时间7(6, 8) d长于保守治疗组的5(4, 6) d, 差异有统计学意义(P<0.000 1), 但2组妊娠时期、合并疾病、治疗前后肾积水程度、WBC计数等比较，差异无统计学意义(P>0.05)。结论 妊娠期合并肾积水主要见于妊娠中晚期，以右侧肾积水为主，多合并泌尿系结石等疾病。对于有症状的妊娠期肾积水患者而言，输尿管支架置入治疗和保守治疗效果相似，但对于合并泌尿系疾病的孕妇，应优先考虑支架置入。Abstract:Objective To summarize the clinical characteristics of hydronephrosis in pregnancy and compare effects of treatment methods.Methods This study included 89 patients with hydronephrosis during pregnancy who were admitted to the Department of Reproductive and Urinary Surgery of Gansu Maternal and Child Health Hospital due to low back pain, fever or abdominal pain, etc. According to different treatment methods, the patients were divided into stent implantation group and conservative treatment group. Age, length of hospital stay, gestation period, complications, degree of hydronephrosis before and after treatment, and white blood cell (WBC) count were compared between the two groups.Results Of 89 patients with hydronephrosis during pregnancy, 97.75% (87/89) patients had mild to moderate hydronephrosis, 69 cases (77.53%) had hydronephrosis on the right side (including bilateral sides), 85 cases (95.51%) were in the middle and late pregnancy, and 25 cases (28.09%) were complicated with urinary calculi. After stenting or conservative treatment, the clinical symptoms of all patients were significantly improved without miscarriage, including 33 cases (37.08%) with complete relief of hydronephrosis, 35 cases (39.33%) with mild hydronephrosis, and 3 cases (3.37%) with moderate hydronephrosis. The mean age of pregnant women in the stent implantation group was (25.60±4.92) years, and that in the conservative treatment group was (28.61±4.54) years, the difference was statistically significant (P<0.05). The median length of hospital stay in the stent implantation group was longer than that in the conservative treatment group, and the difference was statistically significant [7 d (6 to 8 d) versus 5 d (4 to 6 d), P<0.000 1]. However, there were no statistically significant differences between the two groups in pregnancy period, complications, degree of hydronhydrone before and after treatment and WBC count (P>0.05).Conclusion Hydronephrosis during pregnancy is common in the second and third trimesters, hydronephrosis mainly occur on the right side of the pregnant, and they usually present urinary stones and other diseases. For symptomatic patients with hydronephrosis in pregnancy, ureteral stent implantation and conservative treatment have similar outcomes. It seems to be more appropriate to choose ureteral stent implantation for the pregnant women with urinary tract diseases.
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表 1 89例妊娠期合并肾积水患者临床基线资料比较(x±s)
临床特征 n 占比/% 偏侧 左侧 20 22.47 右侧 52 58.43 双侧 17 19.10 妊娠时期 早期妊娠 4 4.49 中期妊娠 59 66.29 晚期妊娠 26 29.21 治疗前肾积水程度 轻度 56 62.92 中度 31 34.83 重度 2 2.25 合并疾病 泌尿系结石 25 28.09 肾盂肾炎 8 8.99 脓毒血症或休克 4 4.49 其他疾病 2 2.25 无 50 56.18 治疗方式 支架置入 58 65.17 保守治疗 31 34.83 治疗后肾积水程度 无积水 33 37.08 轻度积水 35 39.33 中度积水 3 3.37 积水情况未知 18 20.22 
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表 2 不同治疗方式组患者的临床特征比较(x±s)[n(%)]M[P25, P75])
临床特征 支架置入组(n=58) 保守治疗组(n=31) P 年龄/岁 25.60±4.92 28.61±4.54 < 0.01 偏侧 左侧 13(22.41) 7(22.58) 0.46 右侧 36(62.07) 16(51.61) 双侧 9(15.52) 8(25.81) 妊娠时期 早期妊娠 2(3.45) 2(6.45) 0.79 中期妊娠 39(67.24) 20(64.52) 晚期妊娠 17(29.31) 9(29.03) 合并疾病* 泌尿系结石 17(56.67) 8(88.89) 0.47 肾盂肾炎 7(23.33) 1(11.11) 脓毒血症或休克 4(13.33) 0 其他 2(6.67) 0 治疗前肾积水程度 轻度 35(60.34) 21(67.74) 0.62 中度 21(36.21) 10(32.26) 重度 2(3.45) 0 治疗后肾积水程度* 无积水 27(46.55) 6(46.15) 0.12 轻度 30(51.72) 5(38.46) 中度 1(1.72) 2(15.38) 住院时间/d 7(6, 8) 5(4, 6) < 0.01 入院时血白细胞/(×109/L) 11.02(9.11, 13.45) 10.34(7.75, 12.77) 0.36 血白细胞计数变化/(×109/L) -4.12±3.80 -3.56±3.02 0.59 *临床特征中各亚项的占比以各组该特征总例数为分母计算。
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