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大黄牡丹汤灌肠辅助腹腔镜下胆总管切开取石术治疗胆总管结石的临床效果▲
Clinical effect of rhubarb peony decoction assisted laparoscopic choledocholithotomy in the treatment of calculus of common bile duct

微创医学 页码:492-496

作者机构:江西省中西医结合医院,江西省南昌市 330003

DOI:10.11864/j.issn.1673.2024.05.03

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目的 探讨大黄牡丹汤灌肠辅助腹腔镜下胆总管切开取石术治疗胆总管结石的临床效果。方法 选择110例胆总管结石患者为研究对象,按照随机数字表法将患者分为对照组(采用腹腔镜下胆总管切开取石术治疗)和观察组(在对照组基础上联合大黄牡丹汤灌肠治疗),每组55例。比较两组患者治疗前后的临床疗效、视觉模拟评量表(VAS)评分、胃肠功能障碍评分、肝胆功能指标和炎性因子水平的差异。结果 观察组患者的临床疗效优于对照组,差异有统计学意义(P<0.05)。与治疗前相比,治疗后两组患者的VAS评分、胃功能障碍评分均明显降低,且观察组VAS评分、胃功能障碍评分均低于对照组,差异均有统计学意义(均P<0.05)。与治疗前相比,治疗后两组患者的血清丙氨酸转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)、总胆固醇(TC)、总胆红素(TBiL)水平明显降低,且观察组血清ALT、AST、γ-GT水平均低于对照组,而观察组TC、TBiL水平高于对照组,差异均有统计学意义(均P<0.05)。与治疗前相比,两组患者的血清总胆汁酸(TBA)水平均增高,且观察组TBA水平高于对照组,差异均有统计学意义(均P<0.05)。与治疗前相比,治疗后两组患者的血清降钙素原(PCT)、C反应蛋白(CRP)水平均明显降低,且观察组血清PCT、CRP水平低于对照组,差异均有统计学意义(均P<0.05)。结论 大黄牡丹汤灌肠辅助腹腔镜下胆总管切开取石术可有效改善胆总管结石患者术后胃肠功能、肝胆功能,降低炎症因子水平,获得显著的临床疗效。


Objective To investigate the clinical effect of rhubarb peony decoction assisted laparoscopic choledocholithotomy in the treatment of calculus of common bile duct. Methods A total of 110 patients with calculus of common bile duct were selected as research objects. According to the random number table method, patients were divided into a control group (treated with laparoscopic choledocholithotomy) and an observation group (treated with rhubarb peony decoction enema therapy on the basis of the control group), with 55 cases in each group. The clinical efficacy, visual analogue scale (VAS) score, gastrointestinal dysfunction score, hepatobiliary function index and inflammatory factor levels before and after treatment were compared between the two groups. Results The clinical efficacy of the observation group was better than that of the control group, with statistically significant difference (P<0.05). After treatment, the VAS score and gastrointestinal dysfunction score of the two groups were significantly lower than those before treatment, and the above scores in the observation group were lower than those of the control group, with statistically significant differences (all P<0.05).After treatment, the levels of serum alanine transaminase(ALT), aspartate transaminase (AST), γ-glutamyl transpeptidase (γ-GT), total cholesterol (TC) and total bilirubin (TBiL) in the two groups were significantly decreased before treatment, among which the levels of serum ALT, AST and γ-GT were lower, and the levels of TC and TBiL were higher in the observation group than those in the control group, with statistically significanct differences (all P<0.05). Compared with before treatment, the serum TBA levels of the two groups were increased, and the serum total bile acid (TBA) level of the two groups were incresed, which was higher in the observation group than that in the control group, with statistically significant differences (all P<0.05). Compared with before treatment, the levels of serum procalcitonin (PCT) and C-reactive protein (CRP) in the two groups were significantly decreased after treatment, and the levels of serum PCT and CRP in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). Conclusion Rhubarb peony decoction assisted laparoscopic choledocholithotomy can effectively improve the postoperative gastrointestinal function and hepatobiliary function of patients with calculus of common bile duct, reduce the level of inflammatory factors, and obtain significant clinical efficacy.

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