机构地区:[1]安徽中医药大学第一附属医院,安徽合肥230038 [2]安徽省中医药科学院外科研究所,安徽合肥230038
出 处:《中医药临床杂志》2025年第2期374-379,共6页Clinical Journal of Traditional Chinese Medicine
基 金:十二五国家临床重点专科建设项目(财社[2013]239号);安徽省高校科研计划项目自然科学重点项目(2023AH050746)。
摘 要:目的:观察经内镜逆行性胰胆管造影术(Endoscopicretrogradechol-angiopancreatography,ERCP)联合内镜下乳头球囊扩张术(Endoscopic papillary balloon dilation,EPBD)序贯中药治疗肝外胆管结石术后肝郁气滞型患者的临床疗效。方法:选取2021年1月—2023年12月就诊于安徽省中医院普外科60例符合标准的肝外胆管结石患者作为研究对象,按治疗方法分为观察组和对照组,每组各30例,对照组予ERCP联合EPBD治疗,术后予常规西药治疗;以对照组为基础,观察组加服柴胡疏肝散合金铃子散加减,2组疗程均为7天。观察比较2组患者治疗前后的临床疗效、证候积分、炎性指标、肝功能、血清胆汁生化、鼻胆管引流量、胆汁细菌培养以及术后复发率。结果:在临床疗效中,2组患者治疗前后差异比较,无统计学意义(Z=1.647,P=0.099)。2组治疗后的中医症候积分水平均较治疗前明显下降(t=2.108,P=0.039),观察组证候积分改善程度优于对照组(P<0.05)。与治疗前比较,2组患者治疗后的炎性指标、肝功能及血清胆汁生化各项指标均显著改善,且观察组与对照组比较,差异显著(P<0.05)。2组患者术后鼻胆管胆汁引流量均呈增加趋势,观察组术后第3、5、7d天胆汁引流量明显大于对照组(P<0.05)。治疗后,观察组胆汁细菌培养阴性率(83.33%)明显高于对照组阴性率(56.66%),差异有统计学意义(P<0.05)。术后结石复发率中观察组(6.66%)与对照组(30%)比较有统计学意义(P<0.05)。结论:ERCP联合EPBD序贯中药治疗能够有效改善肝功能,抑制胆道细菌,降低术后结石复发,提高患者生活质量。Objective:To observe the clinical efficacy of ERCP combined with EPBD sequential Chinese medicine in treating patients with hepatic depression and Qi stagnation type after extrahepatic bile duct stone surgery.Methods:60 patients who were diagnosed with extrahepatic bile duct stones and met the criteria in the Department of General Surgery of the First subsidiary of the Anhui University of Chinese Medicine(AUCM)from January 2021 to December 2023 were selected and divided into an observation group and a control group according to the different treatments,with 30 cases in each group.The observation group was treated with ERCP combined with EPBD and was given conventional Western medicine treatment after the operation,and the control group was treated with additional treatment of Chaihu Shuo Liver Dispersion and Jinlingzi Dispersion.The clinical efficacy,TCM symptom scores,inflammation indexes,liver function,serum bile biochemical indexes,nasal bile drainage,bacterial culture,and postoperative recurrence rate of the two groups were compared.Results:Comparison of the patient’s therapeutic outcomes before and after therapy in the 2 groups,the results of which were not statistically significant.(Z=1.647,P=0.099).Both groups exhibited marked reductions in their traditional Chinese medicine(TCM)syndrome scores following treatment,as compared to their pre-treatment levels.(t=2.108,P=0.039),The observation group’s symptom scores improved to a level better than that of the comparison group.(P<0.05).Inflammatory indexes,liver function and serum bile biochemical indexes of patients in both groups after treatment are ameliorated compared with those of patients before healing,with a notable distinction evident between the observation and control groups.(P<0.05).Post-surgery,the bile excretion via the nasociliary ducts in both groups escalated,wherein the observation group manifested significantly greater volumes of bile drainage in comparison to the control group on days 3,5,and 7 after the operation.(P<0.05).Following surge
分 类 号:R269[医药卫生—中西医结合]
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