疏肝利胆和胃法治疗保胆取石术后结石复发理论探析  

A theoretical analysis of treating gallstone recurrence after choledochoscopic gallbladderpreserving surgery by the soothing liver-gallbladder and harmonizing stomach therapy

作　　者：夏先朋 刘文生[2] XIA Xianpeng

机构地区：[1]南京中医药大学,江苏南京210000 [2]南京中医药大学附属南京市中西医结合医院,江苏南京210014

出　　处：《中医临床研究》2023年第34期58-61,共4页Clinical Journal Of Chinese Medicine

摘　　要：微创保胆取石术(腹腔镜联合胆道镜微创保胆取石术)因其可以保留胆囊并且减少并发症等优势而被广泛运用于临床,但术后易导致不容忽视的结石复发并发症,其病因复杂,提前预防胆石的形成是最直接有效的方法。中医药在预防结石复发方面进行了诸多探索和研究,运用中医的“治未病”理念并结合中医药个体化辨证思维,逐渐彰显其在防治结石复发及并发症方面的独特优势。中医学认为,术后结石复发病位主要在肝、胆、胃等,三者在生理病理上联系密切,病因多为“肝郁、湿热”等,病机多为“肝胆疏泄失司、脾胃升降失调”等。临床研究证明,术后给予患者疏肝利胆、和胃通腑中药治疗,能够调整患者的机体内环境,从结石复发根源进行阻断,是预防术后结石复发的有效措施。笔者根据临床跟诊、诊治经验,基于“疏肝利胆和胃法”理论,选择从病因病机入手预防结石复发。首先从疏肝为基础入手,调理肝胆气机,行气解郁;再注重胆的枢纽作用,护胆利胆,通腑排石,祛邪固本;还兼顾和胃清热,三者结合,标本兼顾。文章分析结石复发的中西医病因病机,分条阐述结石复发的治则治法,探讨“疏肝利胆和胃法”在预防结石复发方面的可行性,并附验案1例,为中医药防治胆囊结石复发提供有效新思路。Minimally invasive gallbladder-preserving cholecystolithotomy is widely used in clinical practice because it can preserve the gallbladder and reduce complications,but it is easy to lead to lithiasis recurrence complications that cannot be ignored after surgery,and its etiology is complex,and preventing the formation of gallstones in advance is the most direct and effective method.TCM has carried out many explorations and studies in the prevention of lithiasis recurrence,and the use of the concept of preventive treatment of disease combined with the individualized differentiation thinking of TCM has gradually demonstrated its unique advantages in the prevention and treatment of lithiasis recurrence and complications.TCM believes that the recurrence of lithiasis after surgery is mainly in the liver,gallbladder and stomach,and the three are closely related in physiopathology,the causes are mostly liver depression,moist heat,etc.,and the disease mechanism is mostly hepatobiliary negligence,spleen and stomach lifting disorders,etc.Clinical studies have proved that postoperative Chinese medicinal materials for soothing liver and gallbladder,and harmonizing stomach and relaxing bowel can effectively prevent the recurrence of gallstones.The ability to adjust the patient’s internal environment and block the source of lithiasis recurrence is an effective measure for preventing postoperative lithiasis recurrence.Based on clinical follow-up,diagnosis and treatment experience,based on the theory of soothing liver-gallbladder and harmonizing stomach method,the author chooses to prevent the recurrence of lithiasis from the etiology and pathogenesis.First of all,starting from the basis of liver thinning,regulating the liver and biliary Qi(气)movement,and relieving depression.Then we should pay attention to the pivotal role of the gall,protect the gall and choleretic,drain lithiasis through the intestines,and dispel evil.It also takes into account harmonizing stomach and gastric heatiness,combining the three and treating both

关 键 词：保胆取石 结石复发 疏肝解郁 和胃利胆 

分 类 号：R256.4[医药卫生—中医内科学]