蔡蔚 狄奇 谢晓 杨华伟 龙蠡 谢海平 蒋斌 蒋伟平 贺潇 唐汇龙

〔摘要〕 目的 觀察芪金合剂配合输尿管软镜碎石术治疗上尿路结石的临床疗效。方法 将90例输尿管上段结石或肾结石需行输尿管软镜碎石术治疗的患者随机分为治疗1组、治疗2组、对照组各30例。治疗1组术后连续服用芪金合剂治疗，治疗2组术后间断服用芪金合剂治疗，对照组术后配合物理震动排石治疗。所有患者均于术后3 d、1月及6月后复查，观察各组术后残留结石排出情况、术后并发症的情况、肾积水改善率及近期结石复发率。结果 治疗1组与治疗2组、对照组均能明显改善患者上尿路结石症状，治疗1组与治疗2组在术后3 d并发症发生情况、术后1月残石率、术后6月肾积水改善率及结石复发率方面均优于对照组（P<0.05）;治疗1组与治疗2组比较疗效差异无统计学意义（P>0.05）。结论 芪金合剂配合输尿管软镜碎石术治疗上尿路结石能有效降低术后残石率，预防结石再发，疗效显著且无明显不良反应，值得临床应用及深入研究。

〔关键词〕 上尿路结石;芪金合剂;输尿管软镜碎石术;物理震动排石;临床观察

〔中图分类号〕R256.52       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.11.022

〔Abstract〕 Objective To observe the clinical effects of Qijin Mixture combined with flexible ureteroscopic lithotripsy in the treatment of upper urinary calculi. Methods A total of 90 patients with upper ureteral calculi or renal calculi who need to be treated with flexible ureteroscopic lithotripsy were randomly divided into a treatment group 1 （30 cases）， a treatment group 2 （30 cases），and a control group （30 cases）. The treatment group 1 continued to take Qijin Mixture after operation. The treatment group 2 took Qijin Mixture intermittently after operation， and the control group received physical vibration lithotripsy after operation. All patients were reexamined 3 days， 1 month and 6 months after the operation. The discharge of residual microlith， postoperative complications， improvement rate of hydronephrosis and recurrence rate of recent stones of each group were observed. Results The treatment group 1， the treatment group 2 and the control group could significantly improve the symptoms of upper urinary tract stones. The treatment group 1 and the treatment group 2 were better than the control group in terms of the incidence of complications at 3 days after operation， the rate of residual stones in 1 month after operation， the improvement rate of hydronephrosis in 6 months after operation， and the rate of stone recurrence （P<0.05）; There was no significant difference in curative effect between the treatment group 1 and the treatment group 2 （P>0.05）. Conclusion Qijin Mixture combined with flexible ureteroscopic lithotripsy can effectively reduce the rate of postoperative residual stones and prevent the recurrence of stones. The curative effect is significant and there is no obvious side effect. It is worthy of clinical application and further study.

〔Keywords〕 upper urinary calculi; Qijin Mixture; flexible ureteroscopy lithotripsy; physical vibration lithotripsy; clinical observation

泌尿系结石通常分为上尿路结石和下尿路结石，其中上尿路结石（肾和输尿管结石）占95%以上。目前临床上泌尿系结石发病率高达5%～15%，且治疗后容易复发，10年内复发率可达到50%左右[1]，不仅危害身心健康，也不利于生活质量的提升。随着输尿管软镜技术（flexible ureteroscopy lithotripsy， FURL）的出现，由于其微创特点，在上尿路结石的临床治疗中经常被选择使用。……