狄奇 谢晓 谢海平 蒋斌 蒋伟平 贺潇 刘起立 蔡蔚

〔摘要〕 目的 探讨芪金合剂联合硕通镜治疗上尿路结石的有效性与安全性。方法 将80例输尿管上段结石或肾结石需行硕通镜治疗的患者，随机分为综合治疗组与单纯手术组，每组40例，单纯手术组术后仅对症治疗，综合治疗组在单纯治疗组基础上加用芪金合剂治疗。观察两组术后残石排出情况、术后住院时间及术后疼痛视觉模拟评分法（visual analogue scale， VAS）评分、术后尿常规中红细胞及白细胞计数。结果 综合治疗组术后1月结石清除率较单纯手术组高（P<0.05）;综合治疗组术后住院时间、术后1月疼痛VAS评分均低于单纯手术组（P<0.05）;术后1月两组复查尿常规，综合治疗组尿红细胞及白细胞计数低于单纯手术组（P<0.05）。结论 硕通镜术后服用芪金合剂有缩短住院时间、促进残石排出、降低疼痛、血尿等不良反应发生的作用。疗效显著且无明显不良反应，值得临床推广使用及深入研究。

〔关键词〕 芪金合剂;硕通镜;碎石术;上尿路结石;石淋

〔中图分类号〕R277.5       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.07.024

〔Abstract〕 Objective To investigate the efficacy and safety of Qijin Mixture combined with Shuo Tong ureteroscopy in the treatment of upper urinary tract stones. Methods 80 cases of upper ureteral calculi or renal calculi who needed Shuo Tong ureteroscopy treatment were randomly divided into comprehensive treatment group and simple operation group， with 40 patients in each group. The simple operation group only received symptomatic treatment after operation， while the comprehensive treatment group was treated with Qijin Mixture on the basis of simple operation group. The postoperative residual stone discharge， postoperative hospital stay， visual analogue scale （VAS） pain score and the number of red blood cells and white blood cells in urine routine were observed in both groups. Results The stone clearance rate of the comprehensive treatment group was higher than that of the simple operation group （P<0.05）; the postoperative hospital stay and VAS pain score of the comprehensive treatment group were lower than those of the simple operation group （P<0.05）; one month after operation， the total number of urine red blood cells and white blood cells in the urine routine examination in comprehensive treatment group was lower than that of the simple operation group （P<0.05）. Conclusion The use of Qijin Mixture after Shuo Tong ureteroscopy can shorten hospitalization time， promote residual stone discharge， reduce pain， hematuria and other adverse reactions. The curative effect is significant and there is no obvious side effect， which is worthy of clinical application and in-depth study.

〔Keywords〕 Qijin Mixture; Shuo Tong ureteroscopy; lithotripsy; upper urinary tract stone; urolithiasis

泌尿系結石是泌尿外科常见疾病之一，我国总发病率为1%～5%，长江以南地区发病率高达5%～15%，且本病复发率较高，10年内复发率可达到50%[1-2]。尿路结石的形成原因目前尚无定论，考虑与多因素有关，个人体质差异、饮食居住环境等都可以影响其发病率[3]。针对该病的治疗，临床上多以微创手术为主，主要术式有体外冲击波碎石、输尿管镜碎石、输尿管软镜碎石、经皮肾镜碎石[4]。硕通镜碎石为近年来逐渐开展的一种新型术式，许多研究表明硕通镜在泌尿系结石的手术治疗中有良好效果，但其术后并发症及远期复发率尚有待研究[5]。中医药对尿路结石的治疗有独特优势[6]。本研究选定80例上尿路结石患者，随机分为2组，采用本院药剂科自制中药芪金合剂联合硕通镜治疗，探讨芪金合剂治疗上尿路结石的疗效及安全性。……