坦索罗新联合琥珀酸索利那新在预置双J管病例的作用分析

The efficacy of combination solifenacin and tamsulosin for the passive ureteral dilation with preoperative stenting

目的 探讨坦索罗辛和索利那新在缩短输尿管软镜碎石术前双J管病例预置时间中的作用及其缓解症状中的疗效.方法 2008年11月～2013年12月两个中心共收治行输尿管软镜的肾结石患者137例,男85例,女47例,年龄16 ～79岁,采用留置双J管行被动扩张后二期行软镜碎石术.随机分为3组,坦索罗辛联合索利那新1周组（A组46例）,口服索利那新5mg,1次/d、坦索罗辛0.2mg,1次/d联合双J管被动扩张1周后手术;坦索罗辛联合索利那新2周组（B组46例）,口服索利那新5mg,1次/d、坦索罗辛0.2mg,1次/d联合双J管被动扩张2周后手术;对照组仅采用留置双J管被动扩张2周（C组45例）.以USSQ评分评估扩张期间患者置管相关症状.所有患者二期手术中采用F14外径UAS行软镜手术,以UAS肾盂抵达肾盂为置入成功标准.结果 置管7d后,A、B两组USSQ明显低于对照组（P＜0.05）.A、B及C组使用镇痛药物患者分别为4、3、11例,发生膀胱刺激征患者分别为3、2、12例,各组间比较差异均有统计学意义（P＜0.05）.A、B及C组二期手术中UAS置入成功率分别为95.6％、100％及100％,AB两组间相比差异无统计学意义（P＞0.05）,但两组较对照组差异均有统计学意义（P＜0.05）.结论 对于采用双J管行被动扩张的患者,使用坦索罗辛和索利那新不仅可以有效缓解患者症状,而且可以明显缩短置管时间,值得推广。

Objectives To evaluate the efficacy of combination of solifenacin and tamsulosin for the passive ureteral dilation for ureteral access sheath （UAS） placement with preoperative stenting （POS）.Methods 137 patients （male：85,female：47 age：16 ～ 79 yrs） randomly assigned to 3 groups.The solifenacin group were administered solifenacin 5 mg,once per day.The combination group 1 （Group A of 46 cases） were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day after with preoperative stenting for 7 days.The combination group 2 （Group B of 46 cases） were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day after with preoperative stenting for 2 weeks.The control group was placed with stenting without administering any medicine.The observation duration was set at 1 weeks using ureteral stent symptoms questionnaire（USSQ）.The analgesic requirements,successful rate of UAS insertion and rate of ureteral injury were also recorded.Results Seven days after stent placement,analysis of the USSQ showed a significant worsening of scores in all domains in patients not receiving solifenacin plus tamsulosin （Group A＆amp;B vs.C,P 〈 0.05）.No patients experienced clinical significant side effects from solifenacin plus tamsulosin.The successful rate of UAS placement was significantly higher in group A than in group C （P 〈 0.05）,but was not significantly different when compared with group B.The rate of ureteral injury was significantly lower in group A＆amp;B than in group C（P 〈0.05）.The grade of injury was also lower in group A＆amp;B than group C.Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the group C and group A＆amp;B.Conclusions Tamsulosin and solifenacin could be safe and effective for relieving of preoperative stenting related symptoms and shorten the passive dilation duration without compromise its result.