坦索洛辛在输尿管镜碎石术治疗输尿管下段结石中的作用

Role of tamsulosin in management of lower ureteral calculi before ureteroscopic holmium laser lithotripsy

目的:评价α1-受体阻滞剂(坦索洛辛)在经尿道输尿管镜碎石术治疗输尿管下段结石中的临床作用。方法:将符合条件的79例输尿管下段结石患者随机分为坦索洛辛+URSL组和单纯URSL组,两组患者年龄、性别、结石最大直径等差异均无统计学意义。单纯URSL组采用常规经尿道输尿管镜钬激光碎石术(URSL),坦索洛辛+URSL组术前连续服用坦索洛辛0.2 mg/d,2周后再行URSL。结果:坦索洛辛+URSL组只有1例中转开放手术,输尿管镜碎石成功率高达97.5%(39/40),高于单纯URSL组79.5%(31/39)(χ2=4.688,P=0.030),手术和术后住院时间分别为(13.33±4.42)min和(2.54±0.99)天,均短于单纯URSL组(19.19±6.60)min和(3.26±0.93)天(t=4.081,P=0.000;t=3.092,P=0.003),肾绞痛发生率分别为70.0%(28/40)∶89.7%(35/39)(χ2=4.766,P=0.029]。结论:经尿道输尿管镜钬激光碎石术联合坦索洛辛治疗输尿管下段结石能显著提高输尿管镜碎石成功率,缩短手术时间和住院时间,缓解肾绞痛发生。

Objective：To evaluate the potential role of alpha-1 receptor blocker （tamsulosin） in management of lower ureteral calculi before ureteroscopie holmium laser lithotripsy. Methods： 79 patients with symptomatic lower ureteral calculi were enrolled and randomly divided to control group and tamsulosin treatment group. No significant differences were found between two groups for age, gender distribution and maximum stone diameter. The control group was routinely treated by transureteroscopic holmium laser lithotripsy （URSL）. The tamsulosin treatment group was continuously had received tamsulosin （0.2 mg/daily） for two weeks before URSL. Results：One case of tamsulosin group was conversed to open surgery. Compared with the control group, the tamsulosin group was associated with higher ureteroscopic lithotripsy successful rate [97.5%（39/40） vs 79.5%（31/39）, X^2=4.688, P =0.030], shorter operation time [（13.33±4.42） min vs （19.19±6.60） min, t=4.081, P=0.000] and postop-erative hospital stay [（2.54±0.99） d vs （3.26±0.93） d, t=3.092, P=0.003] and less renal colic incidence rate [70.0 % （28/40） vs 89.7%（35/39）, X^2=4.766, P=0.029], respectively. Conclusions：The results had demon- strated that ureteroscopie holmium laser lithotripsy associated with tamsulosin therapy could significantly increase the ureteroscopie lithotripsy success rate, decrease operation time and postoperative hospital stay, release renal colic for the treatment for lower ureteral calculi. Tamsulosin should be added to the first-line adjunctive medical ap- proach for treating lower ureteral calculi.