ESWL联合坦索罗辛治疗输尿管下段结石

目的探讨体外冲击波碎石（ESWL）联合α受体阻滞剂坦索罗辛治疗输尿管下段结石的疗效。方法前瞻性随机对照研究。95例输尿管下段结石患者随机分成对照组（n=46）和试验组（n=49）。对照组ESWL后口服消炎痛（25mg,3次/d）和与坦索罗辛外形相似的安慰剂（2粒,1次/d）;试验组ESWL后口服消炎痛（25mg,3次/d）和坦索罗辛（0.4mg,1次/d）。每例患者观察时间4周。结果对照组和试验组排石率分别为56.5%（26/46）和77.5%（38/49）,两组比较差异有统计学意义（P〈0.01）。两组再次发生肾绞痛而需要镇痛药治疗的患者分别为15.2%（7/46）和8.16%（4/49）,两组比较差异有统计学意义（P〈0.01）;两组平均度冷丁剂量125mg和50mg,两组比较差异有统计学意义（P〈0.001）。结论ESWL联合坦索罗辛治疗输尿管下段结石安全、有效,可显著提高结石清除率,降低肾绞痛发生率及镇痛剂用量。

Combination therapy with extracorporeal shock wave lithotripsy and Tamsulosin for the treatment of lower ureteral stone

Objective To evaluate the efficacy of alpha-adrenergic antagonist in the medical management of lower ureteral stone with ESWL.Methods 95 patients with stone located lower ureter were randomly divided into control group and experimental group.Control group received indomethin and placebo after ESWL,while experimental group received indomethin and tamsulosin after ESWL.All patients had been observed for 2 weeks.Results During 2 weeks,expulsion of stone was 56.5% and 77.5% in control and experimental group,respectively.The difference in expulsion rates was statistically significant（P 0.01）.Renal colic recurred within 2 weeks and analgesics were used in 7 cases（15.2%） in control group and in 4 cases（8.16%） in the experimental group,with statistically significant difference（P 0.01）.Moreover,the mean cumulative pethidine dose was 50 mg per patient in the experimental group and 125 mg per patient in the control group（P 0.001）.Conclusion T amsulosin is safe and effective to enhance clearance in patients with lower ureteral calculus,and adjunctive treatment with tamsulosin could decrease the use of analgesic drugs after ESWL.