鼻胆管注入化石利胆汤对胆总管巨大结石疗效的临床对照研究

发布时间：2018-03-23 23:17

本文选题：胆管巨大结石　切入点：ERCP　出处：《辽宁中医药大学》2015年硕士论文

【摘要】：目的:对比观察ERCP术后置入鼻胆管注入加减化石利胆汤对经EST/EPLBD等术后因手术难度高、操作次数多、手术时间长及患者因身体状况差等原因无法顺利取出全部结石的情况下对肝外胆管巨大结石进一步采用溶石治疗的疗效。材料与方法:本组30例均为来自沈阳军区总医院内镜科与中医科2011年8月至2013年7经ERCP术证实为胆总管巨大结石并于术中无法一次性取出的胆总管巨大结石、嵌顿型结石及充满性结石留置鼻胆管的患者30例,随机分为2组,实验组(n=15)男8例,女7例,53-89岁,平均年龄68.25岁。在常规抗感染、抑酸、抑酶、保肝等西医治疗基础上术后第一天开始经鼻胆管缓慢推注20-50ml“加减化石利胆汤”,封闭鼻胆管末端2h,每日2次,共30天;对照组(n=15)男7例,女8例,46-83岁,平均年龄67.78岁,在上述基础上以同样的方法给予生理盐水对照。观察两组患者第30天超声及ERCP术中胆总管内径及结石的变化情况。结果:所有患者在开始接受治疗中药溶石治疗后接受超声及ERCP术复查,实验组超声下第30天胆总管内径为0.69±0.63cm,对照组为2.84±0.80cm;(P0.01);第二次ERCP(30天)中发现,实验组与对照组完全溶石例数分别为9例(60%)与1例(6.67%),差异有统计学意义(P0.01)。结论:1.经鼻胆管注入中药“加减化石利胆汤”对肝外胆管结石具有碎解、变小甚至完全溶解的作用。2.经鼻胆管主要中药“加减化石利胆汤”可避免部分患者行第2次或反复的ERCP手术。
[Abstract]:Objective: to compare and observe the effect of adding and subtracting fossil Lidan decoction into nasobiliary duct after ERCP on the difficulty of operation and the times of operation after EST/EPLBD and so on. Under the condition that the operation time is long and the patients can not remove all the stones due to their poor physical condition, the effect of further litholysis on extrahepatic bile duct giant calculi is obtained. Materials and methods: all the 30 cases were from Shenyang Army. From August 2011 to June 7, 2013, endoscopy and traditional Chinese Medicine Department of District General Hospital were confirmed by ERCP procedure as giant stones of common bile duct and could not be removed at one time during operation. Thirty patients with incarcerated calculi and filled stones were randomly divided into two groups: the experimental group (n = 8), male (n = 8) and female (n = 7), ranging from 53-89 years old, with an average age of 68.25 years. On the first day after operation, 20-50ml was slowly injected into the nasobiliary duct, the end of the nasobiliary duct was closed for 2 hours, twice a day for 30 days, while the control group consisted of 7 males and 8 females aged 46-83 years, with an average age of 67.78 years. The changes of common bile duct diameter and stones during ERCP and ultrasound on day 30 were observed. Results: all patients received traditional Chinese medicine litholysis therapy at the beginning of treatment. Ultrasound and ERCP were performed. The diameter of the common bile duct was 0.69 卤0.63 cm on the 30th day under ultrasound in the experimental group and 2.84 卤0.80 cm in the control group (P0.01g), and was found on the second day of ERCP(30. There were 9 cases of complete litholysis in the experimental group and 1 case in the control group. The difference was statistically significant (P 0.01). Conclusion: 1. Infusing the nasal bile duct with the Chinese medicine, "add and subtract Shitao Lidan decoction", has a fragmentation effect on extrahepatic bile duct stones. The effect of diminution or even complete dissolution. The main Chinese medicine, "add and subtract fossil Lidan decoction", can avoid the second or repeated ERCP operation in some patients.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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