柴芍四金汤预防ERCP术后胆总管结石复发的临床观察

目的 研究柴芍四金汤预防ERCP术后胆总管结石复发的临床疗效。方法 选取昆山市中医医院脾胃肝胆科2014年1月至2016年12月因胆总管结石行ERCP取石病例120例，按随机数字表法将120例病例随机分为治疗组和对照组，每组各60例，治疗组口服自拟柴芍四金汤，每日1剂，水煎400 mL，分早晚两次温服，随证加减；对照组口服熊去氧胆酸250 mg/次，3次/d，2组均连续药物治疗6月，观察术后2周血清中总胆红素（Tbil）、直接胆红素（Dbil）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）指标、术后半年临床症状（包括腹痛、腹胀、恶心、纳差）及术后6月、12月、18月胆总管结石复发情况。结果 治疗组术后6月、12月及18月结石复发率略低于对照组，但两者差异无统计学意义（ P >0.05）；治疗组在改善腹痛、腹胀、恶心、纳差症状方面优于对照组（ P <0.05）；治疗组在改善血清Tbil、Dbil、ALP、GGT水平方面优于对照组（ P <0.01）。结论 柴芍四金汤能有效预防ERCP术后胆总管结石的复发，且能改善胆总管结石引起的临床症状及血清生化指标。 

Clinical Observation of Chaishao Sijin Decoction on Preventing Recurrence of Choledocholithiasis after ERCP

OBJECTIVE To study the clinical effect of Chaishao Sijin Decoction in preventing recurrence of choledocholithiasis after ERCP. METHODS 120 cases of ERCP for choledocholithiasis from January 2014 to December 2016 in gastroenterology and hepatology department of Kunshan Hospital of Traditional Chinese Medicine were selected. They were randomly divided into treatment group and control group according to the random number table， 60 cases in each group. The treatment group was treated with 400 ml Chaishao Sijin Decoction orally one dose a day， take it warm and twice in the morning and evening. Add or subtract herbs according to the syndrome. The control group was given by 250 mg ursodeoxycholic acid orally three times a day. Two groups were treated continuously for 6 months. The indexes of the serum total bilirubin (Tbil)， direct bilirubin (Dbil)， alkaline phosphatase (ALP)， glutamyl transferase (GGT)， clinical symptoms (including abdominal pain， abdominal distention， nausea， poor appetite) were detected in two weeks after the surgery. Recurrence of choledocholithiasis were recorded 6， 12 and 18 months after operation. RESULTS The recurrence rate of choledocholithiasis in treatment group 6， 12 and 18 months after operation was slightly lower than that in control group but the difference was not statistically significant ( P >0.05); The treatment group was superior to the control group in improving symptoms of abdominal pain， abdominal distension， nausea and poor appetite ( P <0.05); The treatment group was superior to the control group in improving serum Tbil， Dbil， ALP and GGT( P <0.01). CONCLUSION Chaishao Sijin Decoction can effectively prevent recurrence of choledocholithiasis after ERCP and improve clinical symptoms and serum biochemical indexes caused by choledocholithiasis.