手术序贯应用十二味疏肝利胆颗粒治疗肝胆管结石临床研究

目的 观察手术序贯应用十二味疏肝利胆颗粒治疗肝胆管结石的临床疗效.方法 将确诊为肝胆管结石并接受手术治疗的134例患者分为对照组(66例)与观察组(68例).对照组患者手术治疗后常规予以抗感染、护肝、补液等治疗;观察组在对照组治疗方法的基础上,手术后第1天予以口服十二味疏肝利胆颗粒;比较两组患者治疗前后C反应蛋白(C-reaction protein,CRP)水平、肝功能相应指标,以及手术后胆汁颜色、胆汁细菌培养结果、T管引流量和结石累计复发率.结果 手术后3、7 d,观察组患者CRP水平显著低于对照组(P<0.05).手术后7 d,观察组患者丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、γ-谷氨酰转移酶、血清总胆红素、结合胆红素水平显著低于对照组(P<0.05),前清蛋白水平显著高于对照组(P<0.05).手术后7 d,观察组患者胆汁颜色复常率、T管引流量显著高于对照组(P<0.05).手术后25个月内进行随访,观察组结石累计复发率显著低于对照组(8.82％vs 21.21％,P<0.05).结论 手术序贯应用十二味疏肝利胆颗粒有利于控制术后胆管炎症,促进术后肝功能恢复和残余结石排出,防止结石再生.

Clinical Effect of Surgery Followed by Twelve-Flavour Shugan Lidan Granule in Treatment of Hepatolithiasis

Objective To investigate the clinical effect of surgery followed by Twelve-Flavour Shugan Lidan Granule in the treatment of hepatolithiasis. Methods A total of 134 patients who were diagnosed with hepatolithiasis and underwent surgical treatment were divided into control group with 66 patients and observation group with 68 patients. The patients in the control group were given anti-infective, liver-protecting, and fluid infusion therapies, and those in the observation group were given oral administration of Twelve-Flavour Shugan Lidan Granule on day 1 after surgery in addition to the treatment in the control group. The two groups were compared in terms of C-reactive protein (CRP) level and liver function parameters before and after treatment, as well as color of bile, bile bacterial culture results, T-tube drainage volume, and cumulative recurrence rate of stones after surgery. Results At 3 and 7 days after surgery, the observation group had a significantly lower CRP level than the control group (P<0.05). At 7 days after surgery, compared with the control group, the observation group had significantly lower levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, total serum bilirubin, and direct bilirubin (P<0.05) and a significantly higher level of prealbumin (P<0.05). At 7 days after surgery, the observation group had significantly higher normalization rate of bile color and T-tube drainage volume than the control group (P<0.05). The patients were followed up within 25 months after surgery, and the observation group had a significantly lower cumulative recurrence rate of stones than the control group (8.82% vs 21.21%,P<0.05). Conclusion Surgery followed by Twelve-Flavour Shugan Lidan Granule helps to control postoperative bile duct inflammation, promote postoperative liver function recovery and residual calculus expulsion, and prevent recurrence of stones.