三联排石疗法治疗胆总管结石的临床研究

发布时间：2018-05-08 01:40

本文选题：三联排石疗法 + 胆石症　；参考：《安徽中医药大学》2016年硕士论文

【摘要】：目的:观察三联排石疗法治疗胆总管结石(CBDS)的临床疗效。方法:选择安徽中医药大学第一附属医院普外科2013年1月-2015年12月收治的CBDS患者73例,随机分为2组,治疗组37例,按时间节点有规律地使用中药、西药、针灸及脂肪餐的疗法排石治疗;对照组36例,在西药治疗的基础上,给予利胆排石片,疗程1周,观察对比两组的临床疗效。结果:临床研究结果表明三联排石法相对于对照组,在治疗中医临床症状上,总有效率分别为94.59.94%和75.00%,两者都有明显疗效,但治疗组效果更好,有显著性差异(P0.05)。治疗组疾病总有效率为81.08%;影像学疗效总有效率为83.79%;对照组疾病总有效率为66.67%;影像学效总有效率为63.89%。两组疗效对比,均有显著性差异(P0.05),表明三联排石疗法有更好的排石效果。结论:临床研究表明三联排石疗法缓解其临床症状具有较好的效果,能明显消除或改善右上腹疼痛(压痛)、嗳气、纳呆、恶心、厌食油腻等症状,能明显提高排石率,为治疗CBDS提供新思路,新途径。其作用机制考虑为以下几方面:一、中药具有疏泄肝胆的作用,防止胆汁淤积肝脏,促进肝脏大量分泌胆汁,增加胆道内压力,起到内冲洗作用,促进结石排出,为胆道结石排出提供条件;二、中药能调节胆汁成分,消除胆道内炎症因子,破坏结石形成条件,改善胆道内环境,溶解胆道内结石,为排出较大结石提供条件;三、中药结合针灸刺激相应穴位,能加强胆囊及胆管收缩,进一步加强胆道内压力,同时能松弛oddi括约肌,促进结石排出;四、根据人体胆汁分泌、排泄规律,胆管括约肌扩张收缩规律,结石堵塞胆管下端等特点,结合相关药物的疗效,将中药、西药、针灸以及其他治疗措施,按时间点顺序有机地结合起来,集中治疗优势,取得排石的最大可能性,以达到最大程度消除或改善临床症状,提高排石率。
[Abstract]:Objective: to observe the clinical effect of triple lithotomy therapy on choledocholithiasis (CBDS). Methods: from January 2013 to December 2015, 73 patients with CBDS were randomly divided into two groups: treatment group (n = 37), using Chinese medicine and western medicine regularly according to time node. Acupuncture and moxibustion and fat meal therapy for lithotomy treatment, control group of 36 cases, on the basis of western medicine treatment, given Lidan Pai stone tablets, the course of one week, the two groups were observed and compared the clinical efficacy. Results: compared with the control group, the total effective rate of the triple method was 94.59.94% and 75.00%, respectively, but the effect of the treatment group was better than that of the control group (P 0.05). The total effective rate of disease in treatment group was 81.08; the total effective rate of imaging effect was 83.79; the total effective rate of disease in control group was 66.67; the total effective rate of imaging effect was 63.89. There was significant difference between the two groups (P 0.05), which indicated that the triple therapy had better lithogenic effect. Conclusion: the clinical study shows that triple lithotomy therapy has a better effect on relieving clinical symptoms, can obviously eliminate or improve the pain of right upper abdomen (tenderness, belching, anorexia, nausea, anorexia and other symptoms), and can obviously increase the rate of removing stone. To provide a new way for the treatment of CBDS. The mechanism is considered as follows: first, Chinese medicine has the effect of relieving liver and gallbladder, preventing cholestasis of liver, promoting large amount of bile secretion of liver, increasing internal pressure of bile duct, playing an internal washing role, and promoting the excretion of stones. The Chinese medicine can regulate the bile composition, eliminate the inflammatory factors in the bile duct, destroy the conditions for the formation of the stones, improve the internal environment of the bile duct, dissolve the stones in the bile duct, and provide the conditions for the discharge of larger stones; third, Chinese medicine combined with acupuncture and moxibustion to stimulate the corresponding acupoints can strengthen the contraction of the gallbladder and bile duct, further strengthen the pressure in the biliary tract, at the same time relax the sphincter of oddi and promote the excretion of stones; fourthly, according to the rules of bile secretion and excretion of human body, The characteristics of bile duct sphincter dilatation and contraction, stones blocking the lower end of the bile duct, combined with the curative effect of related drugs, the combination of traditional Chinese medicine, western medicine, acupuncture and other treatment measures, combined organically according to the time point sequence, concentrated treatment advantage, The maximum possibility of removing stone is obtained in order to eliminate or improve the clinical symptoms and increase the rate of stone removal.
【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】：2016
【分类号】：R575.62

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