自拟疏肝利胆汤对胆囊切除术后综合征患者胆总管、奥狄氏括约肌测压水平的影响  

Effects of Self-made Shugan Lidan Decoction on Common Bile Ducts and Sphincter of Oddi Pressure in Patients with Post-cholecystectomy Syndrome

作　　者：张瑞倩 ZHANG Rui-qian(Hepatopancreatobiliary Surgery,Lishui City Center Hospital,Lishui Zhejiang(323000),China)

机构地区：[1]浙江丽水市中心人民医院肝胆胰外科,浙江丽水323000

出　　处：《中国中西医结合外科杂志》2022年第4期491-495,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:探讨自拟疏肝利胆汤对胆囊切除术后综合征(PCS)患者胆总管、奥狄氏括约肌(SO)测压水平的影响。方法:选取2020年3月—2021年4月本院收治的48例PCS患者,采用随机单双编号法将患者分为观察组和对照组,每组24例。对照组采用常规西医治疗,观察组在对照组的基础上添加自拟疏肝利胆汤,两组均持续治疗2周。观察两组患者的临床疗效,分别于治疗前后评估两组患者的中医证候积分;采用内镜检测胆总管压力及SO基础压、蠕动频率以及逆向蠕动波;抽取患者清晨空腹静脉血,检测患者的肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)]和相关炎性因子[白细胞介素-4(IL-6)、肿瘤因子-α(TNF-α)]水平;记录两组患者治疗期间的不良反应发生情况。结果:观察组总有效率为87.50%,高于对照组的62.50%,差异有统计学意义(P<0.05);治疗后,观察组食欲减退、腹痛腹胀、腹泻、恶心嗳气证候积分均明显低于对照组(P<0.05);观察组的胆总管内压、SO基础压、蠕动频率、逆向蠕动波明显低于对照组(P<0.05);观察组的ALT、AST、IL-6、TNF-α水平明显低于对照组(P<0.05)。两组患者均无明显头晕、皮疹、胸闷等不良反应发生。结论:自拟疏肝利胆汤方辅助临床西医治疗PCS患者可明显降低胆管及SO压力,改善肝功能,降低炎症反应程度,提高临床疗效。Objective To explore the effects of self-made Shugan Lidan Decoction on common bile ducts and sphincter of oddi(SO)pressure in patients with post-cholecystectomy syndrome(PCS).Methods A total of 48 patients with PCS admitted to the hospital were enrolled between March 2020 and April 2021.The patients were divided into observation group and control group by random single and double labeling method,24cases in each group.The control group was treated with routine western medicine,while the observation group was additionally treated with self-made Shugan Lidan Decoction.Both groups were continuously treated for 2 weeks.The clinical curative effect in both groups were observed.Before and after treatment,scores of TCM syndromes were assessed.The pressure of common bile ducts,basal pressure of SO,peristaltic frequency and reverse peristaltic waves were examined by endoscopy.The fasting venous blood in the morning was collected to detect liver function[alanine aminotrans(ALT),aspartate transaminase(AST)]and related inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)].The occurrence of adverse reactions during treatment in both groups were recorded.Results The total response rate of the observation group was higher than that of the control group(87.50%vs 62.50%,P<0.05).After treatment,scores of TCM syndromes(loss of appetite,abdominal pain and distention,diarrhea,nausea,belching)in the observation group were significantly lower than those in the control group(P<0.05).The pressure of common bile ducts,basal pressure of SO,peristaltic frequency and reverse peristaltic waves were significantly lower than those in the control group(P<0.05),and the levels of ALT,AST,IL-6 and TNF-αwere significantly lower than those in the control group(P<0.05).There were no obvious adverse reactions such as dizziness,skin rash or chest distress in either group.Conclusion The clinical western medicine assisted with self-made Shugan Lidan decoction can significantly reduce pressure of bile duct and SO,improve liver functio

关 键 词：胆囊切除术后综合征 疏肝利胆汤 胆总管 奥狄氏括约肌 

分 类 号：R657.41[医药卫生—外科学]