摘要
目的探讨乌四汤辅助腹腔镜联合胆道镜探查取石术后一期缝合术治疗难治性胆总管结石的临床疗效,以及对患者中医证候积分与肝功能的影响。方法选取医院2021年5月至2024年5月收治的难治性胆总管结石患者120例,按随机数字表法分为观察组和对照组,各60例。两组患者均予腹腔镜联合胆道镜探查取石术后一期缝合术治疗,观察组加用乌四汤。结果观察组总有效率为96.67%,显著高于对照组的85.00%(P<0.05)。观察组患者术后住院、术后进食、肛门首次排气的时间均显著短于对照组(P<0.05),观察组患者的视觉模拟评分法(VAS)评分显著低于对照组(P<0.05)。治疗后,两组患者的中医证候(腹痛腹胀、右肩背胀、消化不良、食欲减退)积分,肝功能指标(丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、直接胆红素、血清总胆红素),T淋巴细胞亚群CD_(3)^(+)和CD_(4)^(+)水平均显著降低,且观察组均显著低于对照组(P<0.05);两组患者的T淋巴细胞亚群CD_(8)^(+)水平均显著升高(P<0.05),且观察组显著高于对照组(P<0.05)。观察组和对照组患者围术期并发症发生率相当(15.00%比18.33%,P>0.05)。结论乌四汤辅助腹腔镜联合胆道镜探查取石术后一期缝合术治疗难治性胆总管结石的临床疗效良好,可降低患者的中医证候积分,改善免疫功能及肝功能指标,减轻术后疼痛程度,且安全性良好。
Objective To investigate the clinical efficacy of Wusi Decoction assisted one-stage suture after laparoscope combined with cholangioscope exploration and stone removal in the treatment of patients with refractory choledochoolithiasis,and its effect on the patients′traditional Chinese medicine(TCM)syndrome scores and liver function.Methods A total of 120 patients with refractory choledochoolithiasis admitted to the hospital from May 2021 to May 2024 were selected and divided into the observation group and the control group by the random number table method,with 60 cases in each group.The patients in the two group were treated with laparoscope combined with cholangioscope exploration and stone removel,on this basis,the patients in the observation group received additional treatment with Wusi Decoction.Results The total effective rate in the observation group was 96.67%,which was significantly higher than 85.00%in the control group(P<0.05).The time for postoperative hospitalization,postoperative feeding,and first anal exhaust in the observation group was significantly shorter than that in the control group(P<0.05),and the visual analog scale(VAS)score in the observation group was significantly lower than that in the control group(P<0.05).After treatment,the scores of TCM syndromes(abdominal pain and bloating,right shoulder swelling,indigestion,decreased appetite),liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),direct bilirubin(DBiL),serum total bilirubin(TBiL),T lymphocyte subsets CD_(3)^(+)and CD_(4)^(+)levels]in the two groups significantly decreased,and those in the observation group were significantly lower than those in the control group(P<0.05).The CD_(8)^(+)level of T lymphocyte subsets in the two groups significantly increased(P<0.05),and that in the observation group was significantly higher than that in the control group(P<0.05).The incidence of perioperative complications in the observation group was comparable to that in the control group(15.00%vs.18.33%,P>0.05).Conclusion Wusi Decoction assisted one-stage suture after laparoscope combined with cholangioscope exploration and stone removel has good clinical efficacy and safety in the treatment of patients with refractory choledochoolithiasis,which can reduce the patients′TCM syndrome score,improve immune function and liver function indexes,and alleviate postoperative pain.
作者
孙太冉
吕建东
席江伟
罗冰清
王瑄
SUN Tairan;LYU Jiandong;XI Jiangwei;LUO Bingqing;WANG Xuan(The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei,China 075100)
出处
《中国药业》
2025年第17期114-117,共4页
China Pharmaceuticals
基金
河北省2023年政府资助临床医学优秀人才培养项目[ZF2023254]。
关键词
乌四汤
腹腔镜联合胆道镜探查取石术
一期缝合术
胆总管结石
中医证候积分
肝功能
临床疗效
Wusi Decoction
laparoscope combined with cholangioscope exploration and stone removel
one-stage suture
choledocholithiasis
TCM syndrome score
liver function
clincal efficacy
