新药物辅助排石疗法在输尿管下段结石的临床研究

目的探讨新药物辅助排石疗法（α1-RB＋NSAIDs）在治疗输尿管下段结石的作用。方法输尿管下段结石患者120例,随机平分为3组。每组患者皆应用左氧氟沙星0.2g,2次/d;吲哚美辛栓1枚,塞肛2次/d;对照组患者加用中成药结石通1.0g,3次/d;组2在对照组基础上加服硝苯地平10mg,3次/d;组3在对照组基础上加服萘哌地尔25mg,2次/d。以结石排出输尿管或治疗随访期满2周为疗效观察终点。结果3组均无因发生药物不良反应而退出研究者。3组患者的平均年龄、性别比例、结石大小比较差异均无统计学意义（P〉0.05）。2周内排出结石者组：组1为15例（37.5%）,组2为28例（70%）,组3为37例（92.5%）。组2、组3与组1的排石率比较有统计学意义（P〈0.05）,而组2与组3间排石率亦有统计学意义（P〈0.05）。组1-组3平均排石时间分别为9d,8d和4d：组1与组3比较差异有统计学意义（P〈0.05）,组2与组1、组3比较差异无统计学意义（P〉0.05）。2周内肾绞痛再次发作：组1有8例（20%）,组2有5例（12.5%）,组3为0例,经肌注酮络酸氨丁三醇30mg或哌替啶50mg后缓解。3组间比较差异有统计学意义（P〈0.05）。结论新药物辅助排石疗法可明显提高输尿管下段结石的排出率,缩短结石排出时间,减少肾绞痛发作概率,可作为输尿管下段结石药物治疗的一线选择。

A Randomized Controlled Clinical Study of Neo-Adjuvant Medical Expulsive Therapy in the Treatment of Lower Ureteral Stones

Objective To explore the clinical efficacy of neo-adjuvant medical expulsive therapy（nMET） in the medical treatment of lower ureteral stones.Methods A total of 120 patients with newly developed stones in the lower ureter were randomly equally divided into 3 groups.The Levofloxacin 0.2g twice daily and Indomathacin blot twice daily per anum for 14 days were the routine medicine.In the control group,40 cases were treated with Chinese medicine Jie-shi-tong 1.0g 3 times daily.Group 2 were received nifedipine 10mg 3 times daily,group 3 were naftopidil 25mg twice daily in addition to the same drugs used in the control group.Ultrasound or radiology follow-up was performed weekly till stone expulsion or till 2 weeks.Results No severe adverse reactions related to the drugs were noted and no patient withdrew from the study.The mean age of the patients,sex distribution and the size of the stones were no significant difference between the 3 groups（P〉0.05）.The stone expulsion rate（within 2 weeks） was 37.5%（15/40） in control group,70%（28/40） in group 2 and 92.5%（37/40） in group 3,with significant difference between group 2,group 3 and the control group（P〈0.05）.The mean expulsion time was 9d,8d and 4d,respectively in three groups,with significant difference between group 3 and control group（P〈0.05）.In three groups,the renal colic recurred within 2 weeks and analgesics were used in 8 cases（20%）,5 cases（12.5%） and 0,respectively,with significant difference（P〈0.05）.Conclusion It is demonstrated that the neo-adjuvant medical expulsive therapy（nMET） is safe and effective and can be used as the first line therapy for the lower ureteral stones.