坦索罗辛联合双氯芬酸钠在输尿管下段结石辅助排石中的作用

Evaluation of efficacy of tamsulosin and diclfenac sodium for medical expulsive treatment of lower ureteral calculi

目的评价坦索罗辛与双氯芬酸钠联合治疗在输尿管下段结石辅助排石中的临床效果。方法91例确诊单纯输尿管下段结石的患者，年龄18～57岁，结石4～10mm，随机分为3组：空白对照组、坦索罗辛（0．2mg，1次／d）对照组、联合治疗组（服用坦索罗辛和双氯芬酸钠）。3组间患者的年龄、性别、结石直径等差异均无统计学意义。随访1周，观察结石排出率、结石排出时间、肾绞痛发生、镇痛剂使用情况和药物不良反应。结果联合治疗组、坦索罗辛组的结石完全排出率分别为90．0％、69．0％，均显著高于对照组的40．0％（P均〈0．05）；结石排出时间、肾绞痛发生率和镇痛剂的使用率分别为（8．20±1．56）d、20．0％、3．3％和（9．21±1．59）d、44．8％、20．7％，也均显著低于对照组的（11．40±1．73）d、64．0％和48．0％（P均〈0．05）。且联合治疗组的结石排出率明显高于坦索罗辛组，结石排出时间、肾绞痛发生率和镇痛药使用率也均低于后者。3组患者均未观察到明显的药物不良反应。结论坦索罗辛联合双氯芬酸钠可明显促进输尿管下段结石排出，缓解肾绞痛发生，可作为一种有效的输尿管下段结石辅助药物疗法。

Objective To evaluate the efficacy of tamsulosin association with diclfenac sodium used to accelerate the expulsion of stones during the medical expulsive treatment of lower ureteral calculi to allow spontaneous passage. Methods A total of 91 consecutive patients with single radiopaque lower ureteral calculi were enrolled in the study. The stone diameter was 4~10 mm and patient age was 18~57 years. All patients were randomized in three groups. Group 1 did not receive any medical treatment as blank control group. Group 2 received tamsulosin 0.2 mg/day and group 3 received tamsulosin plus diclfenac sodium （50mg, twice a day） for two weeks. No significant differences were found among the three groups concerning age, gender distribution and maximum stone diameter. Efficacy was evaluated in term of stone expulsion rate, expulsion time, pain episodes, analgesic use and adverse drug reaction during a week of follow-up. Results The successful stone expulsion rate was 90.0% and 69.0% in the combination treatment group and tamsulosin group, which was significantly higher than 40.0% in the control group （P〈0.05）. The stone expulsion time, pain episodes rate and analgesic use rate were （8.20±1.56） days, 20.0%, 3.3% and （9.21± 1.59） days, 44.8%, 20.7%, which were also significantly lower than those in the control group, which were （11.40±1.73） days, 64.0% and 48.0%, respectively. Moreover, the stone expulsion rate and expulsion time of the combination group were significantly higher than those of the tamsulosin group, while pain episodes rate, analgesic use rate were significantly lower. No serious adverse drug reaction was found in the three groups. Conclusion The combined use of tamsulosin and dicfenac sodium increases stone expulsion and relieves renal colic episode, which should be recommended in the treatment for lower ureteral calculi.