米拉贝隆促进输尿管下段结石体外冲击波碎石术后排石疗效的前瞻性观察究

胡翔; 赵跃广; 舒俊洁; 吕海鸥; 宇瀚 何

doi:10.62177/fcdt.v2i3.1488

Authors

胡翔浙江省金华市永康市第一人民医院（杭州医学院附属永康医院）泌尿外科
赵跃广浙江省金华市永康市第一人民医院（杭州医学院附属永康医院）泌尿外科
舒俊洁浙江省金华市永康市第一人民医院（杭州医学院附属永康医院）泌尿外科
吕海鸥浙江省金华市永康市第一人民医院（杭州医学院附属永康医院）泌尿外科
宇瀚何永康市第一人民医院

DOI:

https://doi.org/10.62177/fcdt.v2i3.1488

Keywords:

输尿管下段结石, 体外冲击波碎石术, 米拉贝隆, 坦索罗辛

Abstract

目的：探究米拉贝隆联合体外冲击波碎石术治疗输尿管下段结石患者的疗效。方法：纳入2023年4月至2025年8月于本院泌尿外科门诊及急诊确诊的227例输尿管下段结石病例，按随机数字表法分为三组：ESWL+米拉贝隆组（85例）、ESWL+坦索罗辛组（80例）和单纯ESWL组（62例）。比较各组在结石清除率、疼痛评分、排尿感受评分及不良反应发生率等方面的差异。结果：三组患者的结石清除率随观察时间延长均呈上升趋势，其中ESWL+米拉贝隆组在术后第3天、第7天及第14天的结石清除率均显著高于另外两组，在疼痛控制方面，ESWL每日肾绞痛发作次数最多，ESWL+Mirabegro组每日肾绞痛发作次数最少（0.7±0.3 vs 0.9±0.5 vs 1.3±0.4；P<0.01）。ESWL+Mirabegron组视觉模拟评分VAS评分（2.8±0.5），排尿感觉评分（1.5±0.7）依次明显优于ESWL+Tamsulosin组、ESWL组（P＜0.05），各组不良反应发生率（如血尿、输尿管损伤、体位性低血压、口干、头痛、便秘）无显著差异（P>0.05）。结论：对于输尿管下段结石患者，米拉贝隆联合体外冲击波碎石术可显著提升结石清除效率、缩短排石病程，并有效缓解疼痛，且不增加不良反应率，是一种更为优化的治疗方案。

Downloads

Download data is not yet available.

References

Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis[J]. J Nephrol, 2001, 13(S45-S50).

Qian X, Wan J, Xu J, et al. Epidemiological trends of urolithiasis at the global, regional, and national levels: a population-based study[J]. Int J Clin Pract, 2022, 2022: 6807203.

Fink HA, Wilt TJ, Eidman KE, et al. Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline[J]. Ann Intern Med, 2013, 158(7): 535-543.

Antonelli JA, Maalouf NM, Pearle MS, et al. Use of the National Health and Nutrition Examination Survey to calculate the impact of obesity and diabetes on cost and prevalence of urolithiasis in 2030[J]. Eur Urol, 2014, 66(4): 724-729.

Li J, Jiang C, Liao X, et al. Ureteral inflammatory edema grading clinical application[J]. Front Surg, 2023, 9: 1038776.

Yamaguchi K, Minei S, Yamazaki T, et al. Characterization of ureteral lesions associated with impacted stones[J]. Int J Urol, 1999, 6(6): 281-285.

Campschroer T, Zhu X, Vernooij RW, et al. Alpha-blockers as medical expulsive therapy for ureteral stones[DB/OL]. Cochrane Database Syst Rev, 2018(4).

Rassweiler J, Rieker P, Rassweiler-Seyfried MC. Extracorporeal shock-wave lithotripsy: is it still valid in the era of robotic endourology? Can it be more efficient?[J]. Curr Opin Urol, 2020, 30(2): 120-129.

Skolarikos A, Neisius A, Petřík A, et al. EAU Guidelines on Urolithiasis[C]//EAU Annual Congress, Amsterdam, 2022.

Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones[J]. J Urol, 2003, 170(6): 2202-2205.

Seitz C, Liatsikos E, Porpiglia F, et al. Medical therapy to facilitate the passage of stones: what is the evidence?[J]. Eur Urol, 2009, 56(3): 455-471.

Dehvari N, da Silva Junior ED, Bengtsson T, et al. Mirabegron: potential off target effects and uses beyond the bladder[J]. Br J Pharmacol, 2018, 175(21): 4072-4082.

Matsumoto R, Otsuka A, Suzuki T, et al. Expression and functional role of β3-adrenoceptors in the human ureter[J]. Int J Urol, 2013, 20(10): 1007-1014.

Sayed MAB, Moeen AM, Saada H, et al. Mirabegron as a medical expulsive therapy for 5-10 mm distal ureteral stones: a prospective, randomized, comparative study[J]. Urol J, 2022, 48(3): 209.

Tang QL, Wang DJ, Zhou S, et al. Mirabegron in medical expulsive therapy for distal ureteral stones: a prospective, randomized, controlled study[J]. World J Urol, 2021, 39(12): 4465-4470.

Solakhan M, Bayrak O, Bulut E. Efficacy of mirabegron in medical expulsive therapy[J]. Urolithiasis, 2019, 47(3): 303-307.

Adamu B, Alhassan SU, Effa EE. Adjunctive medical expulsive therapy for kidney and ureteral stone fragments following shock wave lithotripsy[DB/OL]. Cochrane Database Syst Rev, 2015(5).

Li M, Wang Z, Yang J, et al. Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis[J]. PLoS One, 2015, 10(4): e0122497.

Jones JB, Dula DJ. The efficacy of sublingual hyoscyamine sulfate and intravenous ketorolac tromethamine in the relief of ureteral colic[J]. Am J Emerg Med, 1998, 16(6): 557-559.

Cervenakov I, Fillo J, Mardiak J, et al. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin[J]. Int Urol Nephrol, 2002, 34(1): 25-29.

Ye Z, Yang H, Li H, et al. A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic[J]. BJU Int, 2011, 108(2).

毛敏,唐浩桐,陈彩霞,等.米拉贝隆联合坦索罗辛治疗输尿管支架管相关症状的随机对照研究[J].四川医学,2023,44(9):901-905.