中西医结合治疗胆管闭锁Kasai术后胆管炎的临床研究  

Clinical investigation for integrating Chinese-western therapy in the treatment of cholangitis after biliary atresia Kasai operation

作　　者：赵翊杉 李玉兰[1] 韩娟[1] 赵宝红[2] 刘文跃[2] 任红霞[2] ZHAO Yi-shan;LI Yu-lan;HAN Juan;ZHAO Bao-hong;LIU Wen-yue;REN Hong-xia(Li Yulan Studio,Department of Pediatrics,Taiyuan Traditional Chinese Medicine Hospital,Shanxi,Taiyuan 030013,China;Department of Neonatal Surgery,Children’s Hospital of Shanxi,Shanxi,Taiyuan 030013,China)

机构地区：[1]太原市中医医院儿科李玉兰工作室,山西太原030013 [2]山西省儿童医院新生儿外科,山西太原030013

出　　处：《发育医学电子杂志》2019年第1期38-42,共5页Journal of Developmental Medicine (Electronic Version)

基　　金：山西省中医药管理局科研计划(2016ZYYZ20)

摘　　要：目的探讨中西医结合治疗胆管闭锁Kasai术后胆管炎的临床效果。方法 2014年1月至2017年10月,在山西省儿童医院住院并随访的首次胆管炎患儿共43例。患儿均因黄疸行腹腔镜探查及胆道造影确诊为胆管闭锁,开腹行Kasai手术。发生胆管炎后,对照组以西医常规治疗为主,共20例;研究组以中药大柴胡汤加减结合西医常规治疗,共23例。比较两组患儿的基本情况及治疗前后的谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)。统计学分析采用独立样本t检验。结果研究组与对照组患儿的平均手术日龄^([(65.8±7.3)与(68.6±11.5) d])、胆管炎首次发病日龄^([(107.1±8.7)与(113.1±10.4) d])比较,差异均无统计学意义(P值均>0.05)。研究组与对照组患儿的降温时间^([(4.4±1.6)与(8.3±1.5) d])、黄疸消退时间^([(9.0±1.2)与(14.0±0.7) d])、住院时间^([(15.9±0.9)与(19.5±1.0) d])比较,研究组均低于对照组,差异有统计学意义(P值均<0.05)。胆管炎首次发病时,研究组与对照组患儿的ALT^([(163.0±5.3)与(164.6±8.8)U/L])、AST^([(162.4±6.3)与(164.0±5.9)U/L])、TBIL^([(107.0±2.9)与(106.8±3.5)μmol/L])、DBIL^([(72.9±5.3)与(73.8±2.6)μmol/L])比较,差异均无统计学意义(P值均>0.05)。出院时,研究组的AST和DBIL均低于对照组^([AST分别为(51.1±0.9)与(54.6±0.9)U/L,DBIL分别为(42.0±1.2)与(45.5±0.9)μmol/L]),差异有统计学意义(P值均<0.05)。结论治疗胆管闭锁Kasai术后胆管炎,在西医常规治疗的基础上加用大柴胡汤,可有效降低体温、加速黄疸消退、缩短患儿住院时间。Objective To explore the clinical effect of integrating Chinese-western therapy in the treatment of cholangitis after biliary atresia Kasai operation.Methods From January 2014 to October 2017,43 cases of children with first time of cholangitis were included and followed up in the Children's Hospital of Shanxi.All the children with jaundice who were diagnosed as biliary atresia by laparoscopic exploration and cholangiography performed laparotomy for Kasai surgery.A total of 20 cases with cholangitis were treated with conventional western medicine(control group).The other 23 cases with cholangitis were treated with traditional Chinese medicine Dachaihu decoction combined with western medicine routine treatment(study group).The basic conditions and alanine transferase(ALT),aspartate transaminase(AST),total bilirubin(TBIL)and direct bilirubin(DBIL)of pretherapy and post-treatment of the infants were compared between the two groups.Independent sample t test was used for statistical analysis.Results There was no statistical significance(both P>0.05)at the average age of surgery[(65.8±7.3)vs(68.6±11.5)d]and the onset date of cholangitis[(107.1±8.7)vs(113.1±10.7)d]in two groups.The following indicators in the study group were lower than that of in the control group:the time that body temperature dropped[(4.4±1.6)vs(8.3±1.5)d],the time of the jaundice regression[(9.0±1.2)vs(14.0±0.7)d]and the length of hospital stay[(15.9±0.9)vs(19.5±1.0)d](all P<0.05).There was no statistical significance in ALT[(163.0±5.3)vs(164.6±8.8)U/L],AST[(162.4±6.3)vs(164.0±5.9)U/L],TBIL[(107.0±2.9)vs(106.8±3.5)μmol/L]and DBIL[(72.9±5.3)vs(73.8±2.6)μmol/L]between the two groups when the onset of cholangitis(all P>0.05).The AST and DBIL of the study group were lower than that of the control group[AST(51.1±0.9)vs(54.6±0.9)U/L,DBIL(42.0±1.2)vs(45.5±0.9)μmol/L respectively]at discharge(both P<0.05).Conclusion The addition of Dachaihu decoction on the basis of conventional western medicine treatment can reduce the body temperat

关 键 词：胆管闭锁 胆管炎 大柴胡汤 

分 类 号：R726.5[医药卫生—儿科]