ERCP术后联合一贯煎治疗肝阴亏虚证肝外胆管结石临床观察  

Clinical Effect of Endoscopic Retrograde Cholangiopancreatography Combined with Yiguan Decoction in Treatment of Extrahepatic Bile Duct Stones with Liver-Yin Deficiency

作　　者：刘名扬 张琦[1,2] 齐伟 黄龙 胡高斌[1,2] LIU Mingyang;ZHANG Qi;QI Wei;HUANG Long;HU Gaobin(The First Affiliated Hospital of Anhui University of Chinese Medicine,Anhui Hefei230031,China;Institute of Chinese Traditional Surgery,Anhui Academy of Chinese Medicine,Anhui Hefei230031,China)

机构地区：[1]安徽中医药大学第一附属医院,安徽合肥230031 [2]安徽省中医药科学院外科研究所,安徽合肥230031

出　　处：《安徽中医药大学学报》2024年第6期18-23,共6页Journal of Anhui University of Chinese Medicine

基　　金：“十二五”国家临床重点专科建设项目(财社[2013]239号);“十二五”国家中医药管理局重点专科建设项目(国中医药人教发[2012]32号)。

摘　　要：目的观察内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)联合一贯煎加减治疗肝外胆管结石肝阴亏虚证患者的临床疗效。方法将50例肝外胆管结石患者随机分为对照组和观察组,每组25例。对照组行ERCP取石加常规术后西药治疗,观察组在对照组治疗的基础上加一贯煎加减口服。比较两组患者临床疗效、鼻胆管胆汁引流量、胆汁细菌培养阳性率、肝功能、血清胆汁生化指标、血清炎症指标、结石复发率。结果两组临床疗效比较,差异无统计学意义(P>0.05);术后5、7 d观察组患者鼻胆管胆汁引流量显著少于对照组(P<0.05);观察组患者胆汁细菌培养阳性率显著低于对照组(P<0.05);两组患者治疗后肝功能、血清胆汁生化指标、血清炎症指标水平均较治疗前显著下降(P<0.05),且观察组上述指标水平下降程度显著大于对照组(P<0.05);对照组结石复发率显著高于观察组(P<0.05)。结论ERCP联合一贯煎加减治疗肝外胆管结石肝阴亏虚证,可明显改善患者临床症状和体征,促进患者肝功能恢复,改善患者血清胆汁生化指标,加快术后胆道炎症的消退,从而达到预防结石复发的作用。Objective To investigate the clinical effect of endoscopic retrograde cholangiopancreatography(ERCP)combined with modified Yiguan Decoction in the treatment of patients with extrahepatic bile duct stones with liver-Yin deficiency.Methods A total of 50 patients with extrahepatic bile duct stones were randomly divided into control group and observation group,with 25 patients in each group.The patients in the control group received ERCP lithotomy and conventional postoperative Western medicine treatment,and those in the observation group received oral administration of modified Yiguan Decoction in addition to the treatment in the control group.The two groups were compared in terms of clinical outcome,nasobiliary bile drainage volume,positive rate of bile bacterial culture,liver function,serum bile biochemistry,inflammatory indicators,and stone recurrence rate.Results There was no significant difference in clinical outcome between the two groups(P>0.05).The observation group had a significantly lower bile drainage volume than the control groups on days 5 and 7 after surgery(P<0.05).The observation group also had a significantly lower positive rate of bile bacterial culture than the control group(P<0.05).After treatment,both groups had significant reductions in the levels of liver function parameters,bile biochemical parameters,and inflammatory indicators(P<0.05),and the observation group had significantly greater reductions than the control group(P<0.05).The control group had a significantly higher stone recurrence rate than the observation group(P<0.05).Conclusion In the treatment of extrahepatic bile duct stones with liver-Yin deficiency,ERCP combined with modified Yiguan Decoction can significantly improve clinical symptoms and signs,promote the recovery of liver function,improve bile biochemical parameters,and accelerate the regression of postoperative biliary inflammation,thereby preventing the recurrence of stones.

关 键 词：内镜逆行胰胆管造影术 一贯煎 肝外胆管结石 肝阴亏虚证 

分 类 号：R256.4[医药卫生—中医内科学] R657.3[医药卫生—中医学]