药物治疗对输尿管下段结石患者体外碎石后早期排石的影响

Effect of adjunctive drug therapy on early expulsion of distal ureteral calculi after extracorporeal shock wave lithotripsy

本研究回顾性分析了2021年1—6月在民航总医院泌尿外科实施输尿管下段结石体外碎石的275例患者的临床资料。根据是否应用辅助药物治疗分为对照组和用药组(体外碎石前联合应用酮咯酸氨丁三醇30 mg与间苯三酚80 mg),随访观察两组体外碎石后结石排出率和其他临床结局指标。对照组138例患者,男117例,年龄(42±13)岁;用药组137例患者,男118例,年龄(42±12)岁。两组患者体外碎石后24 h排石率(67.88%比48.55%,P=0.001)、1周排石率(76.64%比57.97%,P=0.001)和4周排石率(89.05%比76.08%,P=0.005)用药组均高于对照组;碎石后疼痛视觉模拟评分(VAS)(1.77±0.80比2.06±1.04,P=0.012)及再次碎石率(8.03%比17.39%,P=0.020)用药组均低于对照组;碎石后6 h内肉眼血尿及药物过敏发生率两组间差异无统计学意义(P>0.05)。证实酮咯酸氨丁三醇与间苯三酚联合辅助治疗可显著提高输尿管下段结石体外碎石术后早期排石率,未见明显不良反应。

Objective To evaluate the efficacy of ketochromate tromethamine and phloroglucinol combination therapy in early expulsion of ureteral calculi after extracorporeal shockwave lithotripsy(ESWL)in patients with distal ureteral clculi.The clinical and follow-up data of 275 patients with lower ureteral calculi who underwent ESWL were collected retrospectively in Civil Aviation General Hospital from January 1st 2021 to June 30th 2021.According to whether adjunctive medication used before ESWL patients were divided into control group and medication group(with ketochromate tromethamine 30 mg and phloroglucinol 80 mg before ESWL).Primary endpoint is the clearance rate of ureteral calculi after ESWL,secondary endpoint are the other outcomes and drug allergy.There were 138 cases in control group[117 were males and mean age(42±13)years].Meanwhile,there were 137 cases in medication group[118 were males and mean age(42±12)years].The clearance rate of ureteral calculi at 24 h(67.88%vs 48.55%,P=0.001)、one week(76.64%vs 57.97%,P=0.001)and four weeks(89.05%vs 76.08%,P=0.005)after ESWL in medication group were significant higher than that in control group.There was a significant difference in the VAS score of pain scale after ESWL(1.77±0.80 vs 2.06±1.04,P=0.012)and re-ESWL rate(8.03%vs 17.39%,P=0.02)between two groups,but no difference with gross hematuria in 6 h after ESWL and drug allergy.Conclusions combination use of ketochromate tromethamine and phloroglucinol significantly improve early expulsion of ureteral calculi after ESWL in patients with distal ureteral calculi,with no side effect.