盐酸坦索罗辛缓释胶囊对输尿管硬镜治疗不同部位输尿管上段结石的价值研究

Clinical value of tamsulosin hydrochloride sustained release capsule in the treatment of upper ureteral calculi in different parts by ureteroscopy

目的:探讨盐酸坦索罗辛缓释胶囊在输尿管硬镜治疗不同部位输尿管上段结石手术中的临床应用价值。方法:回顾性分析自2016年3月至2021年6月在我院接受输尿管硬镜治疗的输尿管上段结石的178例患者临床资料,按其术前是否口服盐酸坦索罗辛缓释胶囊分为用药组(93例)和对照组(85例),对比分析两组手术成功率、肾盏可见率、术中“抱镜”发生率。进而再将两组按照结石所处不同位置分为输尿管上段的上、中、下三个部位,再次对上述指标进行对比分析。结果:用药组的手术成功率和肾盏可见率明显高于对照组(P<0.01),而术中“抱镜”发生率低于对照组(P<0.05)。将输尿管上段结石以肾下极、腰4横突、骶髂关节上缘为界,进一步将上段输尿管分为上部、中部、下部,两组上部和下部结石的手术成功率、肾盏可见率、术中“抱镜”率无显著差异(P>0.05),但是中部结石两组之间差异显著,用药组的手术成功率、肾盏可见率均显著高于对照组(P<0.05),术中“抱镜”的发生率明显低于对照组(P<0.05)。结论:盐酸坦索罗辛缓释胶囊可以松弛输尿管平滑肌,增加输尿管上段结石行输尿管硬镜治疗的成功率,减少术中“抱镜”风险。尤其对于处在肾下极与腰4横突之间的结石优势明显。

Objective:To explore the clinical value of tamsulosin hydrochloride sustainedrelease capsule in the treatment of upper ureteral calculi in different parts by ureteroscopy.Methods:The clinical data of 178 patients with upper ureteral calculi treated by ureteroscopy in our hospital from March 2016 to June 2021 were analyzed retrospectively.According to whether tamsulosin hydrochloride sustainedrelease capsule was taken orally before operation,they were divided into drug group(n=93)and control group(n=85).The success rate of operation,the visible rate of renal calices and the incidence of intraoperative"holding ureteroscopy"were compared and analyzed between the two groups.Then the two groups were divided into upper,middle and lower parts of the upper ureter according to the different positions of the stones,and the above indexes were compared and analyzed again.Results:The success rate of operation and the visible rate of renal calices in the medication group were significantly higher than those in the control group(P<0.01),while the incidence of intraoperative"holding ureteroscopy"was lower than that in the control group(P<0.05).The upper ureteral calculi is bounded by the lower pole of the kidney,the transverse process of L4 and the upper edge of sacroiliac joint,and the ureters were divided into upper,middle and lower parts.For upper and lower parts of upper ureteral calculi,there was no significant difference in the success rate of operation,the visible rate of renal calices and the intraoperative"holding ureteroscopy"rate between the two groups(P>0.05).But for middle pats of upper ureteral calculi,there was differet results.The success rate of operation and the visible rate of renal calices in the medication group were significantly higher than those in the control group(P<0.05),and the incidence of intraoperative"holding ureteroscopy"was significantly lower than that in the control group(P<0.05).Conclusion:Tamsulosin hydrochloride sustainedrelease capsule can relax ureteral smooth muscle,increase the success rate of rigid ureteroscopy for upper ureteral calculi,and reduce the risk of"holding ureteroscopy"during operation.Especially for stones located between the lower pole of the kidney and the transverse process of L4.