石韦散加减汤联合钬激光碎石术治疗湿热蕴结证输尿管上段嵌顿性结石

Clinical observation of modified Shiweisan decoction combined with holmium laser lithotripsy in the treatment of upper ureteral incarcerated stones with dampness-heat amassment pattern

目的观察石韦散加减汤联合钬激光碎石术治疗湿热蕴结证输尿管上段嵌顿性结石的临床疗效。方法选取湿热蕴结证输尿管上段嵌顿性结石患者118例,随机数表法分为对照组与研究组,各59例。2组均予钬激光碎石术治疗,对照组在此基础上予盐酸坦索罗辛缓释胶囊治疗,研究组在对照组的基础上予石韦散加减汤。2组均持续用药1个月。对比2组中医证候积分、临床症状消失时间、尿红细胞(URBC)、尿白细胞(UWBC)、血清降钙素原(PCT)、C反应蛋白(CRP)水平、结石排出时间、结石排出率以及不良反应发生情况。结果研究组血尿、小腹坠胀、尿急、尿频症状消失时间均短于对照组(P<0.05);治疗后,2组中医证候积分、URBC与UWBC均降低(P<0.05),且研究组更低(P<0.05);治疗后,2组血清PCT、CRP水平均降低(P<0.05),且研究组更低(P<0.05);2组并发症发生率比较,差异无统计学意义(P>0.05);研究组术后1个月结石排出率(91.53%,54/59)高于对照组(77.97%,46/59)(P<0.05)。结论石韦散加减汤联合钬激光碎石术治疗湿热蕴结证输尿管上段嵌顿性结石疗效确切,可缩短患者临床症状消失时间,促进碎石排出,降低URBC、UWBC水平,减轻炎症反应,且安全性良好。

Objective To observe the clinical efficacy of modified Shiweisan decoction combined with holmium laser lithotripsy in the treatment of upper ureteral incarcerated calculi with dampness-heat amassment pattern.Methods A total of 118 patients with upper ureteral incarcerated calculi with dampnessheat amassment pattern were selected and divided into the study group and the control group according to random number table method,with 59 cases in each group.Both groups received holmium laser lithotripsy.The control group received tamsulosin hydrochloride sustained-release capsules on the basis of the treatment,and the study group received modified Shiweisan decoction on the basis of the treatment of the control group.Both groups continued to receive medication for 1 month.Traditional Chinese medicine(TCM)symptom score,disappearance time of clinical symptoms,the levels of urinary red blood cells(URBC),urinary white blood cells(UWBC),serum procalcitonin(PCT)and C-reactive protein(CRP),and stone excretion time and stone excretion rate,and adverse reactions in the two groups were compared.Results The disappearance time of symptoms of hematuria,lower abdominal distention,and urgency and frequency of urination in the study group was shorter than that in the control group(P<0.05).After treatment,TCM symptom scores,and URBC and UWBC levels were decreased in both groups(P<0.05),and the study group was lower than the control group(P<0.05).After treatment,serum PCT and CRP levels in both groups were decreased(P<0.05),and the study group was lower than the control group(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).The stone excretion rate(91.53%)in the study group was higher than that in the control group(77.97%)at 1 month after operation(P<0.05).Conclusion Modified Shiweisan decoction combined with holmium laser lithotripsy is effective in the treatment of upper ureteral incarcerated calculi with dampness-heat amassment pattern.This treatment can shorten the disappearance time of clinical symptoms,promote the stone excretion,reduce the levels of URBC and UWBC,and alleviate the inflammatory response,and have good safety.