陷胸三金汤对于难治性胆总管结石内镜下逆行胰胆管造影+支架置入术后预防复发的价值探讨  

Value of Xianxiong Sanjin Decoction(陷胸三金汤)Preventing Recurrence of Refractory Common Bile Duct Calculi after ERCP and Stent Implantation

作　　者：钱鑫 叶小峰 王轶 王晶[1] 苏菡 朱明花 卜玲玲[1] 陶以理 QIAN Xin;YE Xiaofeng;WANG Yi;WANG Jin;SU Han;ZHU Minghua;BU Lingling;TAO Yili(Changzhou Hospital of Traditional Chinese Medicine,Changzhou 213000,Jiangsu,China;Gulou Hospital Affiliated to Nanjing University,Nanjing 210000,Jiangsu,China)

机构地区：[1]常州市中医医院,江苏常州213000 [2]南京大学附属鼓楼医院,江苏南京210000

出　　处：《中华中医药学刊》2022年第9期225-229,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：江苏省六大人才高峰培养项目(WSW-080);常州市第八批科技计划(CE20195039)。

摘　　要：目的探究陷胸三金汤对于难治性胆总管结石内镜下逆行胰胆管造影(encoscopic retrograde cholangio pancreato-graphy,ERCP)+支架置入术后预防复发的价值。方法将医院收治的难治性胆总管结石患者(2018年1月—2020年6月)以随机数字表法分成治疗组与对照组,各50例,对照组50例患者ERCP+支架置入手术治疗,治疗组50例患者则在ERCP+支架置入手术治疗基础上术后采用陷胸三金汤治疗,两组患者临床数据观察:治疗前及治疗1周后中医证候积分(上腹痛、面目俱黄、寒战高热、胸闷纳呆、口渴口苦等)变化、临床治疗效果、患者肛门排气时间及进食时间、下床活动时间、总住院时间、并发症、胆汁生化指标变化、术后3 d及术后7 d引流量、治疗前及治疗后2周后谷草转氨酶(aspartate aminotransferase,AST)及谷丙转氨酶(aLanine amino transferase,ALT)、谷氨酰转肽酶(glutamyl transpeptidase,γ-GT)水平变化及免疫球蛋白A(immunoglobulin A,IgA)及免疫球蛋白G(immunoglobulin G,IgG)、治疗1年后结石复发率。结果经治疗前两组患者中医证候积分(上腹痛、面目俱黄、寒战高热、胸闷纳呆、口渴口苦等)、总胆红素(total bilirubin,TBil)及直接胆红素(serum direct bilirubin,DBil)、间接胆红素(Indirect bilirubin,IBil)、总胆汁酸(total biliary acid,TBA)、钙离子(calcium,Ca)及黏蛋白等胆汁生化指标、AST及ALT、γ-GT、IgA、IgG等指标比较,P>0.05,治疗后各组患者中医证候积分(上腹痛、面目俱黄、寒战高热、胸闷纳呆、口渴口苦等)、TBil、DBil、IBil、TBA、Ca、黏蛋白、AST及ALT、γ-GT、IgA、IgG等指标均改善,治疗组治疗后1周中医证候积分(上腹痛、面目俱黄、寒战高热、胸闷纳呆、口渴口苦等)及治疗后2周、TBil、DBil、IBil、TBA、Ca、黏蛋白、AST及ALT、γ-GT、IgA、IgG等指标优于对照组(P<0.05);与对照组比较,治疗组患者有效率更高(P<0.05);与对照组比较,治疗组患者�Objectire To explore the value of Xianxiong Sanjin Decoction(陷胸三金汤)preventing recurrence of refractory common bile duct calculi afer endoscopic retrograde cholangiopancreatography(ERCP)and stent implantation.Methods Patients with refractory choledocholithiasis admitted to the hospital from January 2018 to June 2020 were divided into treatment group and control group by random number table method,50 patients in each group.Ffty patients in the control group were treated with ER-CP and stent implantation and the other 50 patients in the treatment group were treated with Xianxiong Sanjin Decoction on the basis of ERCP and stent implantation.Observation of clinical data of the two groups:Changes of TCM syndrome scores(epigastric pain,sallow complexion,chills and high fever,chest distress,thirst and btterness,etc.),clinical treatment effect,time of a nal exhaust and eating,time of gtting out of bed,total length of hospital stay and complications before and after treatment for 1 week were observed.Changes of aspertate aminotransferase(AST),alanine aminotransferas(ALT),glutamyl transpeptidase(γ-GT),immunoglobulin A(lgA)and immunoglobulin G(lgG)before and 2 weeks ater treatment were observed.Comparison of stone diameter,one-time stone clearance rate,change of bile biochemical parameters and stone recurrence rate after 1 year of treatment at ERCP 3 months later were observed.Results Before treatment,the scores of TCM syndromes(epigastric pain,sallow complexion,chills and high fever,chest distress,thirst and biterness,etc.),levels of AST,ALT,γ-CT,IgA and IgG were not significant between two groups(P>0.05).After treatment,TCM syndrome scores(epigastric pain,sallow complexion,chills and high fever,chest distress,thirst and bitterness,etc.),levels of AST,ALT,γ-CT,IgA,IgG and other indicators were improved in each group.The TCM syndrome scores of the treatment group(epigastric pain,sallow complexion,chills and high fe-ver,chest distess,hirst and bitermess,ele.)and the indexes of AST,ALT,γ-GT,IgA and IgG in the tre

关 键 词：难治性胆总管 陷胸三金汤 ERCP 支架置入术 疗效 复发 并发症 

分 类 号：R269.574.2[医药卫生—中西医结合]