LC术后应用疏利通泄汤治疗慢性胆囊炎合并胆结石患者对胃肠功能的影响  

Could herbal medicine,Shuli Tongxie Decoction,decrease the relapse of stones in patients with chronic cholecystitis and cholelithiasis after laparoscopic cholecystectomy?

作　　者：曾林 张勇[2] 罗九宝 吉彩云 丹娜 Zeng Lin;Zhang Yong;Luo Jiubao(Department of Pharmacy,Haikou Hospital Affiliated to Central South University Xiangya Medical College,Haikou 570208,Hainan Province,China)

机构地区：[1]中南大学湘雅医学院附属海口医院药学部,海口市570208 [2]中南大学湘雅医学院附属海口医院肝胆外科,海口市570208 [3]海南医学院附属海南医院药学部

出　　处：《实用肝脏病杂志》2023年第4期572-575,共4页Journal of Practical Hepatology

基　　金：海口市科技局科研基金资助项目(编号:2021KL062)。

摘　　要：目的探讨在腹腔镜胆囊切除术(LC)后给予疏利通泄汤治疗慢性胆囊炎合并胆结石患者对胆汁成石成分、应激反应和胃肠功能的影响。方法2018年5月~2021年5月我院收治78例慢性胆囊炎合并胆结石患者,被随机分为两组,均采取LC术治疗。术后,给予对照组熊去氧胆酸治疗,观察组在对照组治疗的基础上给予疏利通泄汤治疗8 w。常规检测血清总胆汁酸(TBA)、间接胆红素(UCB)和钙离子(Ca^(2+))水平,采用ELISA法检测血清白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,采用硫代巴比妥比色法检测血清丙二醛(MDA)水平,采用黄嘌呤氧化酶法检测血清超氧化物歧化酶(SOD)活性,采用放射免疫法检测血清促肾上腺皮质激素(ACTH)水平,采用放射免疫法检测血清胃泌素(GAS)、胃动素(MOT)和血管活性肠肽(VIP)水平。结果在治疗结束时,观察组血清TBA、UCB和Ca^(2+)水平分别为(6.9±1.4)μmol/L、(7.4±1.1)μmol/L和(1.9±0.2)mmol/L,均显著低于对照组【分别为(10.7±1.8)μmol/L、(12.6±1.4)μmol/L和(2.2±0.3)mmol/L,P<0.05】;观察组血清IL-6、TNF-α、ACTH和MDA水平分别(4.8±2.7)ng/L、(1.4±0.2)μg/L、(31.4±3.8)ng/mL和(2.2±0.6)nmol/L,显著低于对照组【分别为(19.6±4.4)ng/L、(2.6±0.3)μg/L、(42.7±4.9)ng/mL和(4.9±0.7)nmol/L】,而血清SOD水平为(149.4±7.1)U/mL,显著高于对照组【(96.6±6.7)U/mL,P<0.05】;观察组血清GAS和MOT水平分别为(103.9±7.9)ng/L和(280.5±13.3)ng/L,显著高于对照组【分别为(93.6±8.1)ng/L和(243.6±14.6)ng/L,P<0.05】,血清VIP水平为(35.9±5.3)pg/mL,显著低于对照组【(49.1±5.7)pg/mL,P<0.05】;术后随访半年,观察组结石复发1例(2.6%),对照组结石复发3例(7.7%),两组差异无统计学意义(P>0.05)。结论应用中药疏利通泄汤治疗LC术后的胆结石患者可能有助于改善胃肠功能,值得进一步研究。Objective The aim of this study was to explore the efficacy of Shuli Tongxie Decoction,herbal medicine,in the treatment of patients with chronic cholecystitis(CC)and cholelithiasis after laparoscopic cholecystectomy(LC).Methods 78 patients with CC and cholelithiasis were enrolled in our hospital between May 2018 and May 2021,and were randomly divided into control group and observation group with 39 cases in each.ALL patients in the series underwent LC,and the patients in the control group were given ursodeoxycholic acid(UDCA),while those in the observation group were treated with UDCA and the herbal medicine combination for 8 weeks.Serum total bile acid(TBA),unconjugated bilirubin(UCB)and calcium ion(Ca^(2+)),serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),adrenocorticotropic hormone(ACTH),malondialdehyde(MDA),superoxide dismutase(SOD),gastrin(GAS),motilin(MOT)and vasoactive intestinal peptide(VIP)levels were routinely detected.Results At the end of the treatment,serum TBA,UCB and Ca^(2+)levels in the combination treatment group were(6.9±1.4)μmol/L,(7.4±1.1)μmol/L and(1.9±0.2)mmol/L,all significantly lower than[(10.7±1.8)μmol/L,(12.6±1.4)μmol/L and(2.2±0.3)mmol/L,respectively,P<0.05];serum IL-6,TNF-α,ACTH and MDA levels were(4.8±2.7)ng/L,(1.4±0.2)μg/L,(31.4±3.8)ng/mL and(2.2±0.6)nmol/L,significantly lower than[(19.6±4.4)ng/L,(2.6±0.3)μg/L,(42.7±4.9)ng/mL and(4.9±0.7)nmol/L],while serum SOD level was(149.4±7.1)U/mL,significantly higher than[(96.6±6.7)U/mL,P<0.05]in the control;serum GAS and MOT levels were(103.9±7.9)ng/L and(280.5±13.3)ng/L,both much higher than[(93.6±8.1)ng/L and(243.6±14.6)ng/L,P<0.05],while serum VIP level was(35.9±5.3)pg/mL,much lower than[(49.1±5.7)pg/mL,P<0.05]in the control;six months after operation,the stone relapsed in one case in the combination group,and that was three cases in the control(P>0.05).Conclusion The oral administration of herbal medicine,Shuli Tongxie Decoction,after LC in preventing stone relapse might be helpful,and needs further c

关 键 词：慢性胆囊炎 胆结石 腹腔镜胆囊切除术 疏利通泄汤 胃肠功能 治疗 

分 类 号：R657.4[医药卫生—外科学]