腹腔镜、胆道镜联合序贯中药治疗肝外胆管结石术后肝郁脾虚证40例

目的 观察腹腔镜、术中胆道镜联合序贯中药治疗肝外胆管结石术后肝郁脾虚型患者的临床疗效，为胆道术后围手术期应用中药提供依据。方法 将40例肝外胆管结石患者随机分为观察组与对照组，每组20例。对照组患者采用双镜联合取石术加常规术后西药治疗；观察组在对照组的基础上，术后加服补中益气汤联合四逆散加减。比较两组患者临床疗效，治疗前后中医证候积分，术后T管胆汁引流量，血炎症指标、肝功能指标、血清胆汁生化指标改善情况。结果 两组患者临床疗效比较，差异无统计学意义（P＞0.05）。治疗后两组患者主症积分、次症积分均较治疗前明显减少（P＜0.05）；除舌淡苔白、脉弦细评分以外，观察组患者主症积分、其余次症积分减少程度显著大于对照组（P＜0.05）。从第5天开始，观察组胆汁引流量明显多于对照组（P<0.05）。治疗后两组患者血炎症指标、肝功能指标、血清胆汁生化指标均较治疗前显著改善（P＜0.05），且观察组各项指标改善显著优于对照组（P＜0.05）。结论 采用双镜联合取石术后序贯补中益气汤和四逆散加减治疗肝外胆管结石肝郁脾虚型患者，可显著改善患者临床症状和体征，改善肝功能，减轻术后炎症反应，减少胆汁淤积。

Clinical Effect of Laparoscopy and Choledochoscopy Combined with Sequential Traditional Chinese Medicine Therapy in Treatment of Liver Depression and Spleen Deficiency after Surgery for Extrahepatic Bile Duct Stones: An Analysis of 40 Cases

Objective To investigate the clinical effect of laparoscopy and intraoperative choledochoscopy combined with sequential traditional Chinese medicine (TCM) therapy in the treatment of patients with liver depression and spleen deficiency after surgery for extrahepatic bile duct stones, and to provide a basis for the application of TCM therapy in the perioperative period after biliary tract surgery. Methods A total of 40 patients with extrahepatic bile duct stones were randomly divided into observation group and control group, with 20 patients in each group. The patients in the control group underwent laparoscopy and choledochoscopy for cholecystolithotomy combined with conventional Western medicine treatment after surgery, and those in the observation group received modified Buzhong Yiqi decoction combined with Sini Powder after surgery in addition to the treatment in the control group. The two groups were compared in terms of clinical outcome, TCM syndrome score before and after treatment, T-tube bile drainage volume after surgery, and improvements in blood inflammatory indices, liver function parameters, and serum bile biochemical parameters after surgery. Results There was no significant difference in clinical outcome between the two groups (P>0.05). After treatment, both groups had significant reductions in the scores of major and minor symptoms (P<0.05), and compared with the control group, the observation group had significantly greater reductions in the scores of all major and minor symptoms except pale tongue with a white coating on the tongue and fine and string-like pulse (P<0.05). Since day 5 after surgery, the observation group had a significantly higher T-tube bile drainage volume than the control group (P<0.05). After treatment, both groups had significant improvements in blood inflammatory indices, liver function parameters, and serum bile biochemical parameters (P<0.05), and the observation group had significantly better improvements than the control group (P<0.05). Conclusion In the treatment of patients with liver depression and spleen deficiency after surgery for extrahepatic bile duct stones, laparoscopy and choledochoscopy combined with sequential modified Buzhong Yiqi decoction and Sini Powder after surgery can significantly improve their clinical symptoms and signs, ameliorate liver function, alleviate postoperative inflammatory response, and reduce cholestasis.