输尿管软镜钬激光碎石术后联用坦索罗辛对结石残留预防及输尿管功能恢复的临床疗效研究

Clinical study on the efficacy of combined use of tamsulosin with flexible ureteroscopic lithotripsy for residual stone prevention and ureteral function recovery

摘要:

目的 探讨输尿管软镜钬激光碎石术（FURL）后联用坦索罗辛对结石残留预防及输尿管功能恢复的疗效，旨在为输尿管结石（UC）的治疗提供临床指导。方法 该研究为一项前瞻性、随机、开放标签和阳性对照的临床试验。选取2023年7月－2025年7月该院收治的UC患者96例，采用随机数表法分为安慰剂组（采用FURL治疗，口服安慰剂）与坦索罗辛组（采用FURL联合坦索罗辛治疗），各48例。统计两组排石时间、结石清除率、术后4周结石残留率和围手术期并发症；比较术后1和4周输尿管支架相关症状调查问卷（USSQ）评分；术前、术后4周计算估算肾小球滤过率（eGFR）、血肌酐（Cr）、血尿素氮（BUN）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。结果 坦索罗辛组排石时间短于安慰剂组，术后4周结石残留率低于安慰剂组，差异均有统计学意义（P < 0.05）；两组患者结石清除率比较，差异无统计学意义（P > 0.05）；两组患者术后4周尿路症状、身体疼痛、全身健康状况、工作表现、性功能和附加问题评分较术后1周降低，且坦索罗辛组明显低于安慰剂组，差异均有统计学意义（P < 0.05）；两组患者术后4周eGFR较术前升高，且坦索罗辛组高于安慰剂组，差异均有统计学意义（P < 0.05）；两组患者术后4周Cr、BUN和NGAL较术前降低，且坦索罗辛组低于安慰剂组，差异均有统计学意义（P < 0.05）。坦索罗辛组和安慰剂组围手术期并发症的发生率分别为14.58%和33.33%，坦索罗辛组低于安慰剂组，差异有统计学意义（P < 0.05）。结论 FURL后联合坦索罗辛治疗，可促进UC患者结石排出，降低术后结石残留率，改善输尿管支架相关症状，促进肾功能及肾小管损伤指标恢复，且安全性良好，对输尿管功能恢复具有积极作用，可作为FURL术后辅助治疗的优选方案。

Abstract:

Objective To explore the efficacy of combined use of tamsulosin with flexible ureteroscopic lithotripsy (FURL) for residual stone prevention and ureteral function recovery, aiming to provide clinical guidance for the treatment of ureteral calculus (UC).Methods This study was a prospective, randomized, open-label and positive-controlled clinical trial. A total of 96 UC patients admitted to our hospital from July 2023 to July 2025 were selected, and randomly divided into the placebo group (treated with FURL, oral placebo) and the tamsulosin group (treated with FURL combined with tamsulosin), with 48 cases in each group. The stone passage time, stone clearance rate, postoperative 4-week stone residual rate, and perioperative complications were recorded. The ureteral stent symptom questionnaire (USSQ) scores at 1-week and 4-week postoperatively were compared. Preoperative and postoperative 4-week estimated glomerular filtration rate (eGFR), serum creatinine (Cr), blood urea nitrogen (BUN), and neutrophil gelatinase-associated lipocalin (NGAL) levels were assessed.Results The stone passage time of the tamsulosin group was shorter than the placebo group, and the postoperative 4-week stone residual rate was lower than the placebo group, and the differences were statistically significant (P < 0.05). No statistically significant difference was observed in the stone clearance rate in both groups (P > 0.05). At 4 weeks postoperatively, scores for urinary symptoms, physical pain, overall health status, work performance, sexual function, and additional issues in both groups were reduced compared to 1 week postoperatively, the tamsulosin group scores were lower than those of the placebo group, and the differences were statistically significant (P < 0.05). The eGFR increased in both groups at 4 weeks postoperatively, with the tamsulosin group being higher than the placebo group (P < 0.05). Cr, BUN, and NGAL levels decreased in both groups at 4 weeks postoperatively compared with before operation, the tamsulosin group was lower than the placebo group, and the differences were statistically significant (P < 0.05). The perioperative complication rate of the tamsulosin group was 14.58%, and the placebo group was 33.33%, the tamsulosin group was lower, and the difference was statistically significant (P < 0.05).Conclusion The combination of tamsulosin with FURL postoperatively can promote stone excretion in UC patients, reduce the postoperative residual stone rate, alleviate ureteral stent-related symptoms, enhance renal function and tubular injury indicators, and demonstrate good safety, positively contributing to ureteral function recovery.