口服消炎利胆片对肝内胆管结石术后患者胆汁成分的影响  

The Effect of Oral Xiaoyan Lidan Tablets on The Bile Composition in Patients with Intrahepatic Bile Duct Stones

作　　者：刘洋[1] 程南生[1] 叶辉[1] 李富宇[1] 陈利平[1] 游蓁[1] 周荣幸[1] 

机构地区：[1]四川大学华西医院胆道外科,成都610041

出　　处：《中国普外基础与临床杂志》2014年第10期1198-1202,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的观察肝内胆管结石患者行胆道探查、T管引流术后,口服消炎利胆片对其胆汁成分(总胆汁酸、胆固醇、磷脂等)的影响,探讨消炎利胆片对胆管结石术后患者结石复发的可能预防作用。方法将连续40例因肝内胆管结石行胆道探查、T管引流术的患者随机分为实验组和对照组,每组各20例。实验组患者于术后第4天开始口服消炎利胆片,对照组不用任何药物,均在术后第1、2、3、7、14及21天经T管采集胆汁,测定2组患者胆汁中总胆汁酸(TBA)、胆固醇(CHO)及磷脂(PLIP)含量,计算TBA/CHO比值及PLIP/CHO比值,并对实验结果进行统计学分析。结果 2组患者的一般资料包括年龄、性别、身高、体质量指数、术前合并疾病、术后并发症、手术时间、住院时间、血清总胆红素、直接胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶及淀粉酶的差异均无统计学意义(P>0.05)。实验组患者术后第1、2及3天胆汁中TBA、CHO及PLIP含量和TBA/CHO及PLIP/CHO比值与对照组比较差异均无统计学意义(P>0.05);术后第7、14及21天胆汁中的TBA、CHO及PLIP含量比对照组均明显增高(P<0.05),其相对应的术后第7、14及21天的TBA/CHO比值分别为2.17±0.29、2.29±0.44和2.59±0.58,PLIP/CHO比值分别为2.03±0.68、2.84±0.64和2.86±0.77,均比对照组明显升高(P<0.05)。结论消炎利胆片可促进肝内胆管结石患者术后肝脏TBA、CHO及PLIP的分泌,使胆汁中TBA及PLIP含量增加,胆汁酸池体积增加,进而使胆汁中TBA/CHO及PLIP/CHO比值上升,改变胆汁中CHO、TBA及PLIP三者的相对构成比,使胆汁中的有形成分不易析出形成结石,从而降低胆色素结石患者术后复发的可能。Objective To observe the effects of oral Xiaoyan Lidan tablets(XYLDT) on the bile composition(total bile acids, cholesterol, phospholipids) in patients with intrahepatic duct stones after common bile duct exploration(CBDE) with T tube drainage, to explore its possible preventive effects on stone recurrence. Methods Forty consecutive patients with intrahepatic bile duct stones who underwent CBDE with T tube drainage were randomly divided into experimental group and control group. XYLDT were administrated at day 4 after surgery in experimental group(n=20), while none of medication were given in control group(n=20). 2 mL of bile was collected through T tube in both groups at day 1, 2, 3, 7, 14, and 21 postoperatively. Total bile acids(TBA), cholesterol(CHO), and phospholipids(PLIP) in bile were measured, and TBA/CHO ratio and PLIP/CHO ratio were calculated respectively. The results were statistical analyzed. Results The demographic data in both groups including age, gender, height, weight, preoperative concomitant diseases, operative time, postoperative complications, hospital stays, serum total bilirubin, direct bilirubin, alanine aminotransferase(ALT), aspartate aminotransferase(AST), and amylase were not signifi cantly different(P>0.05).The measurements of TBA, CHO, PLIP, and the ratio of TBA/CHO and PLIP/CHO in bile were not signifi cant on day 1, 2, and 3 after surgery in both groups(P>0.05). In experimental group, the TBA, CHO, and PLIP on day 7, 14,and 21 after surgery were signifi cantly increased compared with the control group(P<0.05). The ratio of TBA/CHO on day 7, 14, and 21 was 2.17±0.29, 2.29±0.44, and 2.59±0.58, the ratio of PLIP/CHO was 2.03±0.68, 2.84±0.64, and 2.86±0.77, respectively, which were also signifi cantly increased compared with the control group(P<0.05). Conclusions Oral XYLDT can increase the secretion of TBA, CHO, and PLIP, elevate the TBA/CHO and PLIP/CHO ratio, and change the bile composition which may increase the dissolution of cholesterol in the bile. Presumably, oral XYLDT

关 键 词：消炎利胆片 肝内胆管结石 总胆汁酸 胆固醇 磷脂 

分 类 号：R657.4[医药卫生—外科学]