摘要
目的探究消炎利胆汤结合经内镜逆行性胰胆管造影术治疗胆总管结石临床疗效及安全性。方法研究合计纳入87例胆总管结石患者,均由医院2018年2月—2020年2月收治,采取随机数字表法将其分为两组,予以对照组患者(43例)经内镜逆行性胰胆管造影术治疗,予以观察组患者(44例)消炎利胆汤结合经内镜逆行性胰胆管造影术治疗,比较两组患者治疗效果、治疗前后中医症状(腹痛、发热、恶心呕吐、黄疸等)积分变化、患者术后腹痛缓解时间、胃肠功能恢复时间及理化检验恢复正常时间、住院时间、术后1 d、术后10 d、术后15 d患者疼痛(视觉模拟疼痛评分法,VAS)评分、术后1 d及术后4 d、术后7 d胆汁引流量、治疗前后总胆汁酸(TBA)、总胆红素(TBil)及间接胆红素(IBil)、直接胆红素(DBil)等胆汁生化指标变化、治疗前后总胆红素(TBIL)、血清γ谷氨酰转移酶(GGT)、血清天冬氨酸转氨酶(AST)、血清丙氨酸转氨酶(ALT)水平等指标、并发症情况及6个月复发率。结果观察组患者与对照组均手术成功,治疗有效率分别为100.00%(44/44)、97.67%(42/43),P>0.05;治疗前,两组患者腹痛、发热、恶心呕吐、黄疸等中医症状积分、TBA、TBil、IBil、DBil、TBIL、GGT、AST、ALT指标比较,P>0.05,治疗后各组患者腹痛、发热、恶心呕吐、黄疸等中医症状积分、TBA、TBil、IBil、DBil、TBIL、GGT、AST、ALT指标均改善,观察组患者治疗后腹痛、发热、恶心呕吐、黄疸等中医症状积分、TBA、TBil、IBil、DBil、TBIL、GGT、AST、ALT指标均优于对照组,P<0.05;观察组患者腹痛缓解时间、胃肠功能恢复时间及理化检验恢复正常时间、住院时间均短于对照组,P<0.05;观察组患者术后1 d、术后10 d、术后15 d VAS评分均优于对照组,P<0.05;术后1 d,两组患者胆汁引流量比较,P>0.05,术后3 d及术后7 d观察组患者胆汁引流量多于对照组,P<0.05;观察组患者并发症率(0.00%)低于对照组患者(11.63%,5/43),6个月复发率(0.00%)低于对照组(9.30%,4/43),P<0.05。结论消炎利胆汤结合经内镜逆行性胰胆管造影术治疗胆总管结石效果显著,改善患者肝胆功能,缓解患者疼痛,降低患者并发症率及6个月结石复发率,安全可靠,值得应用。
Objective To explore the clinical efficacy and safety of Xiaoyan Lidan Decoction(消炎利胆汤)combined with endoscopic retrograde cholangiopancreatography in the treatment of choledocholithiasis.Methods Combined study included 87 patients with common bile duct calculi,all by our hospital in February 2018 to February 2020,take a random number table method,it can be divided into two groups,to the control group patients(43 cases)by endoscopic retrograde pancreatic angiography treatment,to observe group(44 cases)in patients with anti-inflammatory cholagogue decoction combined with endoscopic retrograde pancreatic angiography treatment,Compare two groups of patients before and after treatment,treatment of traditional Chinese medicine symptoms(abdominal pain,fever,nausea,vomiting,jaundice,etc.),patients with postoperative abdominal pain relief time integral change,gastrointestinal function recovery time and the physical and chemical inspection returned to normal time,length of hospital stay,postoperative 1 d,10 d after operation,postoperative patients with 15 d pain(visual analog pain score,VAS)score,1 d after operation and postoperative 4 d,7 d postoperative bile flow,before and after treatment the total bile acid(associates),total bilirubin(TBil)and indirect bilirubin(IBil),direct bilirubin(DBil)bile biochemistry indexes such as changes,total bilirubin before and after treatment(TBIL),serum glutamyltransferase(GGT),serum aspartate aminotransferase(AST),serum alanine aminotransferase(ALT)levels,complications and recurrence rate at 6 months.Results All patients in the observation group and the control group were operated successfully,and the effective rate of treatment was 100.00%(44/44)and(97.67%,42/43),respectively,P>0.05.Before the treatment,two groups of patients with abdominal pain,fever,nausea,vomiting,jaundice and other traditional Chinese medicine symptom integral,associates,TBil,IBil,DBil,TBil,GGT,AST,ALT index comparison,P>0.05,the treatment group patients after abdominal pain,fever,nausea,vomiting,jaundice and so on TCM symptoms integral,associates,TBil,IBil,DBil,TBil,GGT,AST,ALT indexes improvement,After treatment,the score,TBA,TBil,IBil,DBil,TBil,GGT,AST,ALT and other indicators of traditional Chinese medicine symptoms in the observation group were all better than those in the control group,P<0.05.The time of abdominal pain relief,gastrointestinal function recovery,normal time of physical and chemical examination,and length of hospital stay in the observation group were shorter than those in the control group(P<0.05).VAS scores of patients in the observation group were better than those in the control group at 1d,10d and 15d after surgery(P<0.05).Comparison of bile drainage volume between the two groups on day 1 after operation showed P>0.05;comparison of bile drainage volume between the observation group and the control group on day 3 and 7 after operation showed that the bile drainage volume was higher than that of the control group(P<0.05).The complication rate in the observation group(0.00%)was lower than that in the control group(11.63%,5/43),and the recurrence rate in 6 months(0.00%)was lower than that in the control group(9.30%,4/43),P<0.05.Conclusion Xiaoyanlidan Decoction combined with endoscopic retrograde cholangiopanography in the treatment of choledocholithiasis has a significant effect,improving the hepatobiliary function of patients,relieving pain,reducing complication rate and stone recurrence rate of 6 months,which is safe and reliable and worthy of application.
作者
刘刚
周自忠
刘益
曾燕
LIU Gang;ZHOU Zizhong;LIU Yi;ZENG Yan(The Third People's Hospital of Zigong,Zigong 643020,Sichuan,China)
出处
《中华中医药学刊》
CAS
北大核心
2021年第11期206-209,共4页
Chinese Archives of Traditional Chinese Medicine
基金
四川省卫生厅科研项目(140296)。
关键词
胆总管结石
消炎利胆汤
经内镜逆行性胰胆管造影术
疗效
肝功能
胆汁生化指标
Common bile duct stones
Xiaoyan Lidan Decoction(消炎利胆汤)
Endoscopic retrograde cholangiopancreatography
Curative effect
Liver function
Biochemical index of bile
