输尿管下段结石体外冲击波碎石术后坦索罗辛和索利那新辅助排石的疗效比较

Combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy

目的比较坦索罗辛和索利那新对输尿管下段结石ESWI。后辅助排石和缓解疼痛的疗效。方法2009年11月至2011年5月收治的输尿管下段结石患者120例，男100例，女20例。年龄18～67岁。随机分为4组，每组30例。结石直径0．5～1．1em。所有患者采用x线定位下ESWL治疗后，对照组不采取任何辅助排石措施；索利那新组口服索利那新5mg，1次／d；坦索罗辛组口服坦索罗辛0．2mg，1次／d；坦索罗辛联合索利那新组口服索利那新5mg，1次／d、坦索罗辛0．2mg，1次／d。所有患者治疗观察期2周。结果2周后跟据KUB检查结果评估各组结石排净率，对照组为80．0％（24／30），索利那新组为83．3％（26／30），坦索罗辛组为93．3％（28／30），联合治疗组96．7％（29／30）。坦索罗辛组与对照组比较，差异均有统计学意义（P〈0．05）。联合治疗组与其余3组相比，差异均有统计学意义（P〈0．05）。对照组、索利那新组、坦索罗辛组、联合治疗组排石时间分别为（7．64-3．7）、（6．3±2．5）、（4．4±2．3）、（3．54-2．2）d，联合治疗组、坦索罗辛组与对照组比较差异均有统计学意义（P〈0．05）。对照组、索利那新组、坦索罗辛组、联合组使用镇痛药物患者分别为13、5、9、3例，发生膀胱刺激征患者分别为12、6、10、4例，各组间比较差异均有统计学意义（P〈0．05）。结论在输尿管下段结石行ESWI．后，使用坦索罗辛和索利那新辅助排石安全、有效，能缩短排石时间、缓解疼痛、改善膀胱刺激症状，坦索罗辛和索利那新联合应用疗效更好。

Objective To evaluate the efficacy of combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extraeorporeal shock wave lithotripsy. Methods 120 patients （ male ： 100 female ： 20 age ： 18 - 67 yrs） randomly assigned to 4 groups （ each group 30） with the calculi diameter range from 0.5 to 1.1 cm. All patients performed extracorporeal shock wave lithotripsy （ X ray oriented）. The control group did not accept any medical treatment. The solifenacin group were administered solifenaein 5 rag, once per day. The tamsulosin group were administered tamsulosin 0. 2 mg, once per day. The combination group were administered solifenacin 5rag, plus tamsulosin 0.2 mg, each per day. The observation duration was set at 2 weeks. Results The stone-free rate （ according to KUB） within 2 weeks were 80.0% , 83.3% , 93.3% and 96.7% in the control group, solifenacin group, tamsulosin group and combination group respectively. Statistical differences were significant among the tamsulosin group, the com- bination group and the control group. The stone expulsion times were （7.6±3.7） d, （6.3 ± 2.5 ） d, （4.4 ±2.3 ） d and （ 3.5 ±2.2） d in the 4 groups respectively. Statistical differences were significant among the tamsulosin group, the combination group and the control group. The uses of analgesics were 13, 5, 9 and 3 in the 4 groups respectively. The bladder irrtative symptoms were 12, 6, 4 and 4 in the 4 groups respectively. Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the solifenacin group, the combination group and the control group. Conclusions Tamsulosin and solifenaein could be safe and effective for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy. It could significantly improve the stone expulsion rate, relief the pain and improve bladder irrtative symptoms.