坦索罗辛联合双氯芬酸钠对输尿管下段结石的疗效研究

Efficacy of expulsive therapy using tamsulosin and diclofenac sodium for distal ureteral calculus

目的比较不同剂量坦索罗辛联合双氯芬酸在输尿管下段结石中的疗效。方法将90例门诊输尿管下段结石患者随机分为3组。结石大小为4～10mm。组1为对照组，等待自然排石；组2为小剂量坦索罗辛（0．2mg，qn）＋双氯芬酸钠（50mg，bid）组；组3为标准剂量坦索罗辛（0．4mg．qn）＋双氯芬酸钠（50mg，bid）组。每例患者治疗时间≤2周。结果服药2周后结石排出情况：组1有11例（36．7％），组2有23例（76．7％），组3有25例（83．3％）。组2、3与组1比较排石率有显著差异（P〈O．05）。3组平均排石时间分别为10．3、5．1和5．3d，组2、3与组1比较差异有统计学意义（P〈0．05），但组2与组3之间无显著差异。3组中因再发肾绞痛而行镇痛治疗者分别为8例（26．7％）、3例（10％）和2例（6．7％）．组间比较差异有显著性（P〈0．05）。服药期间3组均未出现严重药物副作用。结论坦索罗辛联合双氯芬酸钠治疗输尿管下段结石安全、有效．二者有协同作用．推荐用小剂量坦索罗辛＋双氯荟醚方案。

OBJECTIVE To compare the efficacy of different doses tamsulosin and diclofenac sodium for the adjunctive expulsive therapy in patients with inferior segment of ureteral calculus. METHODS 90 out-patients with stones （4--10mm） located in the distal ureter（juxtavesical or intramural tract） were randomly divided into 3 groups（30 cases in each group）. Group 1 served as controls;group 2 received low-dose tansulosin（0.2mg, once a night） and diclofenac sodium （50rng, twice a day）for two weeks; and group 3 received standard-dose tamsulosin （0.4mg/night） and diclofenac sodium （50mg, twice a day） up to 14 days. RESULTS During 2 weeks, expulsion of caculus was observed in 11 cases （36.7%） of group 1, in 23 （76.7%） of group 2, and 25 （83.3%） of group 3. The difference in expulsion rates for groups 2, 3 vs group 1 was statistically significant （P 〈 0.05）. The mean expulsion time of groups 1,2 and 3 was 10.3, 5.1 and 5.3 days respectively, with significant difference for groups 2 and 3 vs groups 1 （P 〈 0.05）, but no significant difference between groups 2 and 3 （P 〉 0.05）. In groups 1, 2 and 3, renal colic recurred within 2 weeks and pethidine was used in 8 cases （26.7 % ）, 3 （10 % ）and 2（6.7 % ） respectively, with significant difference for groups 2 and 3 vs group 1 （P 〈 0.05） .No serious side effect occurred.CONCLUSION It is demonstrated that both doses of tamsulosin and diclofenac sodium are safe and effective for inferior segment of ureteral calculus. They have synergetic effect for the expulsive therapy. The program of low-dose tansu[osin and diclofenac sodium was recommended.