1133例胆总管结石发生年龄与生物学特征及中医证型关系探讨  

The Relationship Between the Age of Choledocholith and the Biology Feature and the Type of Traditional Chinese Medicine Syndrome

作　　者：刘志新[1] 林一帆[1] 朱虹[1] 巩阳[1] 刘杨[1] 陆宇平[1] 高文艳[1] 季芳[1] 雷春红[1] 李昊燃[1] 盛天骄[1] 王长洪[1] 

机构地区：[1]沈阳军区总医院中医科,国家中西医结合消化病重点学科,辽宁沈阳110016

出　　处：《中华中医药学刊》2012年第7期1660-1662,共3页Chinese Archives of Traditional Chinese Medicine

摘　　要：目的:探讨胆总管结石的发生年龄与生物学特征及中医证型的关系。方法:对2003年1月-2011年1月,经腹部超声、CT、MRCP检查,ERCP乳头切开取石,最终确诊为胆总管结石的1133例患者的发病年龄、结石部位、大小、数目与中医证型特点,及相互关系进行分析。结果:本组胆总管结石多发年龄在40～93岁(94.4%),其中,21～40岁患者占6.9%,41～60岁患者占31.5%,61～93岁患者占61.6%,各年龄段之间发病率差异有统计学意义(P<0.01)。中医辨证结果显示,61～93岁患者中以肝阳不足证为主,其次为肝气虚弱(41.4%,30.5%),41～60岁患者中以肝气虚弱为主,其次为肝郁气滞(32.8%,31.9%),21～40岁患者中以肝郁气滞为主,其次为肝血亏虚(35.9%,33.3%),不同年龄段的患者中医证型构成不同,差异有统计学意义(P<0.01)。中高龄段患者除胆石发生率高外,还显示出随着年龄增长,出现胆石易复发、大结石多、合并胆囊结石与肝内胆管结石多、多发结石多的特点,与低龄段比较,差异有统计学意义(P<0.01)。结论:胆总管结石好发在中老年,具有易复发、结石大、易多发、多合并胆囊结石与肝内结石的特点。机体随年龄增长而出现的肝血亏虚、肝郁气滞证、肝气虚证、肝阳不足证与胆总管结石发生关系密切。胆总管结石的防治,对高龄段患者宜益气温阳为主,中龄段宜疏肝散结与益气温阳并用,低龄段患者宜养血柔肝与疏肝散结并用。Objective： To approach the relationship between choledocholith and the biology feature and type of syndrom of traditional Chinese medicine（TCM）.Method： 1133 patients in the department of TCM and the Endoscope Department at the General Hospital of Shenyang Military Area From Jan 2003 to Jan 2011 were diagnosed as choledocholith by ultrasound,CT,MRCP,EST,calculus removed with mechanical lithotripsy and reticular basket.The relationship between choledocholith and the biology feature and type of syndrom of TCM were analyzed.Result： The high incidence of choledocholithiasis was 40～93（94.4%）,among them,patients aged 21～40 were 6.9%,aged 41～60 were 31.5% and aged 61～93 were 61.6%.There was significance difference between each age range（P〈0.01）.The result of differentiation of symptoms and signs display that dificiency of liver-Yang and deficiency of liver-Qi were mainly in age 61～93（41.4%,30.5%）,deficiency of liver-Qi and stagnation of Qi due to depression of the liver were maily in age 41～60（32.8%,31.9%）,stagnation of Qi due to depression of the liver and deficiency of liver-blood were maily in age 21～40（35.9%,33.3%）,there were significance differences between each age range（P〈0.01）.Besides the high incidence it showed easy relapse,more big stone and complicating cholecystolithiasis and calculus of intrahepatic duct in advanced age（P〈0.01）.Conclusion： Choledocholith more easily develops in middle and advanced age,and showed easy relapse,more big stone and complicating cholecystolithiasis and calculus of intrahepatic duct.The lithogenesis has the closs relationship to deficiency of liver-blood,stagnation of Qi due to depression of the liver,deficiency of liver-Qi and dificiency of liver-Yang with the age growing.Prevention and treatment should be benefiting vital energy and warming Yang in advanced-age,dispersing the depressed liver-energ and removing stasis together with benefiting vital energy and warming Yang in middle-age,keeping blood and softening liver t

关 键 词：胆总管结石 年龄 辨证 病因 

分 类 号：R575.62[医药卫生—消化系统]