利胆排石汤联合手术治疗胆总管结石临床研究  

Clinical Study of Lidanpaishi Tang Combined with Operation in Treating Choledocholithiasis

作　　者：高鹏程[1] 

机构地区：[1]河西学院附属张掖人民医院,甘肃张掖734000

出　　处：《新中医》2017年第8期81-84,共4页New Chinese Medicine

摘　　要：目的 :观察中药利胆排石汤联合内镜乳头切开术治疗胆总管结石的临床疗效。方法 :回顾性分析本院2013年1—2016年1月收治的200例胆总管结石患者的临床资料,分为治疗组与对照组各100例。治疗组口服中药利胆排石汤联合经内镜乳头括约肌切开术治疗,对照组仅给予经内镜乳头括约肌切开术治疗。比较2组治疗前后症状积分,术后第1、3、5、7天肝汁引流量情况,总胆红素(TBil)、淀粉酶(AMY)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平及结石排出率、并发症情况。结果:治疗后,2组中医症状积分疗效比较,右上腹痛刺痛或压痛、恶心呕吐,差异均无统计学意义(P>0.05);而在改善身目发黄、胸闷纳呆、口苦咽干、发热、大便干、小便赤黄症状上比较,差异均有统计学意义(P<0.05)。2组术后第1天胆汁引流量比较,差异无统计学意义(P>0.05),而术后第3、5、7天治疗组胆汁引流量均多于对照组,差异均有统计学意义(P<0.05);治疗后,2组AMY、TBil、AST、ALT水平分别与治疗前比较,均降低,差异均有统计学意义(P<0.05);2组AMY、TBil、AST、ALT水平比较,差异均有统计学意义(P<0.05);术后半个月经B超复查显示,结石排出率治疗组100%,对照组79.0%,2组结石排出率比较,差异有统计学意义(P<0.05);术后并发症发生率治疗组2.0%,对照组11.0%,2组并发症发生率比较,差异有统计学意义(P<0.05)。结论:利胆排石汤联合内镜乳头括约肌切开术治疗胆总管结石临床疗效优于单纯手术治疗,可改善患者临床症状,提高术后胆汁引流量,且结石排出率高,并发症少。Objective： To observe the clinical effect of Lidanpaishi tang combined with endoscopic sphincterotomy in treating choledocholithiasis. Methods. Retrospective analysis was given to clinical data of 200 patients with choledocholithiasis that our hospital received and cured from January 2013 to January 2016, and divided the patients into the treatment group and the control group being 100 cases in each. The treatment grqup was given oral Lidanpaishi tang combined with endoscopic sphincterotomy while the control group was given endoscopic sphincterotomy only. Compared symptom score of the two groups before and after treatment, biliary drainage after the first, third, fifth and seventh day of operation, condition of total bilirubin （TBil）, amylase （AMY）, aspartate aminotransferase （AST）, alanine transaminase （ALT）, lithagogue rate and complications. Results, After treatment, compared Chinese medicine symptoms score of the two groups, there was no significance in the difference of prickling, tenderness of right upper abdom nausea and vomiting （P 〉 0.05）. Compared improvement in symptoms of yellowing in body and eyes, dyspnea and anorexia, fever, constipation, yellow urine, the difference was significant （P 〈 0.05）. Compared bile drainage of the two groups after the first day of operation, there was no significant difference （P 〉 0.05）; After the third, fifth and seventh day of operation, bile drainage of the treatment group was more than that of the control group, the difference being significant （P〈 0.05）. After treatment, level of AMY, TBil, AST and ALT of the two groups were all lower than those before treatment, the difference being significant （P 〈 0.05）; The differences between level of AMY, TBil, AST and ALT of the two groups were significant （P 〈 0.05）. After half month of operation, result of B ultrasonic examination suggested that lithagogue rate of the treatment group was 100%, and was 79.0% in the control group, difference of the two groups being signifi

关 键 词：胆总管结石 利胆排石汤 经内镜乳头括约肌切开术 总胆红素(TBil) 淀粉酶(AMY) 天冬氨酸氨基转移酶(AST) 丙氨酸氨基转移酶(ALT) 排石率 

分 类 号：R575.62[医药卫生—消化系统]