解痉药物在输尿管镜取石术中的临床应用

Clinical application of antispasmodic drugs in ureteroscopic lithotripsy

目的 探讨术前使用输尿管解痉药物在输尿管镜取石术中的临床价值.方法 将252例输尿管结石患者随机分为5组,A组50例为对照组；B组51例,给予间苯三酚80 mg/天,静滴；C组50例,给予α受体阻滞剂（坦索罗辛）0.4 mg/天,口服；D组49例,给予山莨菪碱10 ng,2次/天,静滴；E组52例,给予黄体酮40mg/天,肌注.解痉治疗3天后,采用wolf 8.0/9.8F硬性输尿管镜行输尿管镜下碎石取石术.结果 本组252例均获成功,结石清除率为98.8％（249/252）,在输尿管镜进镜中,直视下进镜组E与组A、组D差异具有统计学意义,P＜ 0.05；而在导丝引导下仍未到达结石部位,组E与组A差异具有统计学意义,P＜ 0.05.在并发症发生率方面,组A与组B、组C、组D及组E相比,差异具有统计学意义,x 2=27.04,P=0.000,而组B、组C、组D及组E相比,差异无统计学意义,P＞ 0.05；术后随访3～ 18个月,平均9月,结石无复发,未见输尿管狭窄.结论 术前使用解痉药物能松弛输尿管平滑肌,使输尿管松弛和舒张,可显著降低术中输尿管损伤的发生率.以黄体酮的效果相对较好.

Objective To explore clinical value of preoperative use of ureteral antispasmodic drugs in ureteroscopy lithotripsy.Methods 252 patients with ureteral calculus were randomly divided into five groups：Group A with 50 patients,as the control group; Group B,51 patients,were treated with Phloroglucinol （80 mg,ivgtt,once daily）; Group C,50 patients,were treated with tamsulosin （0.4 mg,po,once daily）,Group D,49 patients,were treated with 654-2 （10 mg,ivgtt,twice daily）; Group E,52 patients,were treated with progesterone （40 mg,im,once daily）.All groups were given anti-inflammatory treatment preoperatively.8.0/9.8 F rigid ureteroscope was used for ureteroscopic lithotomy or lithotripsy 3 days after antispasmodic treatment.Results The operation was successful in all cases.The overall stone-free rate was 98.8％（249/252）.In the operation,there was statistical difference in using reteroscope under direct vision between group A and E （P ＜ 0.05）.There were statistical differences in postoperative complication incidence between group A and B,C,D,E （P ＜ 0.05）.After 3-18 months＇ （average 9 months） follow-up period,there was no recurrence and no ureterostenosis was found.Conclusions Routine preoperative use of antispasmodic drugs can relax ureteral smooth muscle,make the ureter relaxed and diastolic,and significantly lower the incidence of intraoperative ureteral injuries.The antispasmodic effect of progesterone is the best among several antispasmodic drugs,with few side effects.