坦索罗辛联合甲基泼尼松龙对输尿管上段结石体外震波碎石术后辅助排石作用的研究

Evaluation of Tamsulosin Combined with Methylprednisolone as Medical Expulsive Therapy after ESWL in Patients with Proximal Ureter Calculi

目的评估坦索罗辛联合甲基泼尼松龙对输尿管上段结石体外震波碎石(ESWL)术后辅助排石作用的有效性及安全性。方法 109例输尿管上段结石患者ESWL术后,随机分为A组(34例)、B组(33例)及C组(42例),分别应用尿石通、尿石通+坦索罗辛、尿石通+坦索罗辛+甲基泼尼松龙辅助排石,随访2月。结果 A,B,C组的结石排净率分别为50.0%,63.6%,81.0%(C组vs A组,P<0.01),结石排出时间为(3.35±1.16)d,(2.10±1.22)d,(1.54±0.85)d(B组、C组vs A组,P<0.01)。石街形成8例,其中A组6例,B组和C组各1例(C组vs A组,P<0.05)。3组肾绞痛发生人次分别为(0.38±0.60),(0.15±0.36),(0.10±0.37)(C组vs A组,P<0.05)。C组药物副作用发生率为11.9%(5/42),无一例因副作用停药。结论输尿管上段结石ESWL术后采用坦索罗辛联合甲基泼尼松龙治疗能够增加结石清除率、缩短排石时间、降低石街形成率并减少肾绞痛的发生,用于辅助排石安全有效。

Objective To evaluate the efficacy and safety of tamsulosin combined with methylprednisolone as adjuvant expulsive therapy in patients with upper ureteral calculi after extracorporeal shock wave lithotripsy（ESWL）.Methods109 patients with single upper ureteral calculus who underwent ESWL were randomly divided into three groups,group A（34 patients）received a traditional chinese medicine（Niaoshitong）,group B（33 patients） received Tamsulosin and Niaoshitong while group C（42 patients） received Methylprednisolone plus Tamsulosin and Niaoshitong.All patients were followed up regularly for 2 months,stone free status was confirmed with both a plain X-ray of the urinary tract and urinary ultrasonography.ResultsThe stone-free rate was 50.0%,63.6%,81.0% for group A,B and C,respectively（group C vs A,P〈0.01）.The mean expulsion time was（3.35±1.16） days in group A,（2.10±1.22） days in group B,and（1.54±0.85） days in group C（group C and B vs A,P〈0.01）.Six patients in group A,1 in group B and 1 in group C developed steinstrasse（group C vs A,P〈0.05）.The mean frequency of ureteral colic was（0.38±0.60）,（0.15±0.36） and（0.10±0.37） person-times respectively in the three groups（group C vs A,P〈0.05）.Side effect occurred in 11.9%（5/42）patients receiving tamsulosin and methylprednisolone,all were minimal and did not require cessation of therapy in any patients.ConclusionsTamsulosin combined with methylprednisolone is effective in assisting stone clearance,decreasing expulsion time,reducing steinstrasse formation and colic episodes in patients with proximal ureter stones following ESWL,with acceptable minimal and low side effects.