腹腔镜胆总管探查联合十二味疏肝利胆冲剂治疗肝外胆管结石的临床研究

发布时间：2018-04-18 02:33

本文选题：十二味疏肝利胆冲剂 + 肝外胆管结石　；参考：《安徽中医药大学》2015年硕士论文

【摘要】：目的:观察腹腔镜胆总管探查联合十二味疏肝利胆冲剂治疗肝外胆管结石的临床疗效。方法:将安徽中医药大学第一附属医院普外1科2012年1月-2014年12月收治住院并手术的肝外胆管结石患者47例,随机分为2组。对照组24例,行腹腔镜胆总管探查术、术中胆道镜、T管引流术,术后给予常规补液、抗感染治疗;研究组23例,在对照组疗法的基础上给予十二味疏肝利胆冲剂口服,每次1袋,1日3次,疗程为2周。治疗结束后分别观察2组手术前及术后7天的中医证候、血常规、肝功能、血清胆汁生化等指标,术后第1d、3d、5d、7dT管引流量,术后腹腔引流时间、术后补液量及住院时间、住院总费用,随访远期并发症等之间的差异。采用SPSS 17.0统计软件进行数据统计处理,计量资料采用t检验,用—x±s表示;计数资料采用x2检验;P0.05认为差异有统计学意义。结果:两组手术前中医证候、血常规、肝功能、血清胆汁生化差异无显著性(P0.05);同组术后7天中医证候评分与手术前比较,差异有显著性(P0.01),术后7天,两组间中医证候评分比较,差异有显著性(P0.01);同组术后7天WBC、N%与手术前比较,差异有显著性(P0.05或P0.01),术后7天,两组WBC计数、N%比较,差异有显著性(P0.01);同组术后7天ALT、AST、AKP、GGT、TBA、TBIL、CB、UCB与手术前比较,差异有显著性(P0.01),术后7天,两组ALT、AST、AKP、GGT、TBA、TBIL、CB、UCB比较,差异有显著性(P0.01);两组术后第1天、第3天T管胆汁引流量变化比较,差异无显著性(P0.05),术后第5天、第7天T管胆汁引流量变化比较,差异有显著性(P0.05或P0.01);两组腹腔引流时间、术后补液量、住院时间及总费用比较,差异有显著性(P0.05或P0.01)。结论:腹腔镜胆总管探查联合十二味疏肝利胆冲剂治疗肝外胆管结石临床疗效的研究表明:(1)十二味疏肝利胆冲剂能改善腹腔镜胆总管探查T管引流术后患者肝胆湿热证候;(2)腹腔镜胆总管探查术后应用十二味疏肝利胆冲剂具有控制胆道感染、减轻胆道炎症作用;(3)腹腔镜胆总管探查术后应用十二味疏肝利胆冲剂具有恢复肝功能、调节肝脏代谢作用;(4)腹腔镜胆总管探查术后应用十二味疏肝利胆冲剂具有促进胆汁的分泌与排泄、减轻胆汁淤积作用;(5)腹腔镜胆总管探查术后应用十二味疏肝利胆冲剂可以缩短患者住院时间,减少治疗费用;(6)腹腔镜胆总管探查术后应用十二味疏肝利胆冲剂可能具有防治术后结石复发的作用。中医中药对于胆石症的预防、治疗及康复等方面不仅具有重要的临床意义,而且也带来了良好的社会效应,中西医结合治疗胆石疾病有着诱人的前景,值得今后进一步深入系统研究。
[Abstract]:Objective: to observe the clinical effect of laparoscopic choledochus exploration combined with 12 kinds of Shugan Lidan granule in the treatment of extrahepatic cholelithiasis.Methods: from January 2012 to December 2014, 47 patients with extrahepatic cholelithiasis were randomly divided into 2 groups.In the control group, 24 cases were treated with laparoscopic choledochus exploration, intraoperative choledochoscope T-tube drainage, routine fluid resuscitation and anti-infection treatment after operation, and 23 cases in the study group were given oral administration of 12 kinds of Shugan Lidan granule on the basis of the control group.Each time 1 bag, 3 times a day, the course of treatment is 2 weeks.After treatment, the TCM syndrome, blood routine, liver function, serum bile biochemistry and other indexes were observed before and 7 days after operation respectively, and the drainage volume, the volume of fluid rehydration and the hospitalization time of the two groups were observed at the 1st day, 3 days after operation, 5 days after operation, 7 days after operation, and 7 days after operation, respectively.Differences in total hospital costs and long-term complications during follow-up.The statistical data were processed by SPSS 17.0 statistical software, the measurement data were expressed by t-test and -x 卤s, and the counting data were expressed by using x2 test (P0.05), the difference was statistically significant.Results: there was no significant difference in TCM syndrome, blood routine, liver function and serum bile biochemistry between the two groups before operation, and there was significant difference in TCM syndrome score between the same group on the 7th day after operation and before operation, and on the 7th day after operation, there was a significant difference between the two groups in TCM syndrome score.On the 7th day after operation, there was a significant difference in the WBC count between the two groups (P 0.05 or P 0.01), and on the 7th day after operation, there was a significant difference between the two groups in the WBC count (P 0.01), and in the same group on the 7th day after operation, there was a significant difference between the same group and the pre-operation group (P 0.01), and on the 7th day after operation, there was a significant difference between the same group and the pre-operation group (P 0.01), and on the 7th day after operation, there was a significant difference in the WBC count between the two groups (P < 0.05), the difference between the two groups was significant (P < 0.05), and the difference between the two groups was significant (P < 0.05).The difference between the two groups was significant (P 0.01), but there was no significant difference between the two groups on the first day, the third day after operation, the difference was not significant (P 0.05), but on the 5th day and the 7th day after operation, there was no significant difference between the two groups in the volume of bile drainage from T tube, and there was no significant difference between the two groups in the volume of bile drainage from T tube on the 5th and 7th day after operation.There was significant difference between the two groups (P 0.05 or P 0.01), the time of abdominal drainage, the amount of fluid rehydration, the time of hospitalization and the total cost, there was significant difference between the two groups (P 0.05 or P 0.01).Conclusion: the clinical effect of laparoscopic choledochus exploration combined with 12 kinds of Shugan Lidan granule in the treatment of extrahepatic cholelithiasis shows that 12 kinds of Shugan Lidan granule can improve the liver and bile duct after laparoscopic choledochus exploration and T tube drainage in patients with extrahepatic choledocholithiasis.After laparoscopic choledochus exploration, twelve kinds of Shugan Lidan granule were used to control biliary tract infection.After laparoscopic choledochus exploration, twelve kinds of Shugan Lidan granule were used to restore liver function.Regulating the function of liver Metabolism after Laparoscopic choledochus exploration, the application of 12 kinds of Shugan Lidan granule can promote the secretion and excretion of bile.After laparoscopic choledochus exploration, the application of 12 kinds of Shugan Lidan granule can shorten the hospitalization time of the patients.The application of 12 kinds of Shugan Lidan granule after laparoscopic choledochus exploration may have the effect of preventing and treating the recurrence of stones after laparoscopic choledochus exploration.Chinese medicine not only has important clinical significance for the prevention, treatment and rehabilitation of cholelithiasis, but also brings good social effect.It is worth further systematic study in the future.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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