中药疏肝利湿方结合经皮穿刺肝胆管引流术治疗恶性梗阻性黄疸的临床研究

目的：分析中药疏肝利湿方结合经皮穿肝胆管引流术（PTCD）治疗恶性梗阻性黄疸的疗效。方法：在PTCD基础上加用中药疏肝利湿方治疗恶性梗阻性黄疽患者30例，观察其治疗前后血清总胆红素（TB）、结合胆红素（DB）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）、7谷氨酰基转移酶（γ-GT）、临床症状、卡氏评分变化及治疗后每日胆汁引流量并与单纯PTCD组27例比较。结果：治疗后两组患者的TB、DB、ALT、AST、ALP、γ-GT均明显下降，临床症状明显改善、卡氏评分明显上升；在降低TB、DB、ALT、改善临床症状、增加卡氏评分及每日胆汁引流量方面治疗组更为显著（P〈0．05）。总有效率治疗组优于对照组但无统计学意义（P〉0．05）。结论：中药疏肝利湿方能显著降低恶性梗阻性黄疸患者TB、DB、ALT水平、缓解临床症状、提高生存质量。

Clinical Effect of Chinese Traditional Medicine with PTCD in Treating Malignant Obstructive Jaundice

Objective： To evaluate the clinical effect of percutaneous transhepatic cholangiodrainage （PTCD） and traditional Chinese medicine on the treatment of malignant obstructive jaundice. Methods： A total of 30 patients with malignant obstructive jaundice were given traditional Chinese medicine after PTCD （the treatment group）. Of them, 27 patients underwent PTCD along （the control group）. Blood samples were collected before and after the treatment. Serum concentrations of TB, CB, ALT, AST, AI.P and γGT were measured. Clinical manifestation, Karnofski grade and daily bile flux were recorded and com- pared with the control group. Comparisons were also made between pre-treatment parameters and corresponding post treatment parameter. Results： Serum concentrations of TB, DB, ALT, AST, ALP andγ-GT all significantly decreased in patients from both groups. Improvement in clinical manifestation and Karnofski grade were observed in both groups. The treatment group showed better effect in decreasing serum concentrations of TB, DB, ALT, improving clinical manifestation and Karnofski grade, and reducing daily bile flux（P〈0.05）. The total effective rate was insignificantly higher in the treatment group（P〉0.05）. Conclusion： Traditional Chinese medicine was effective in decreasing serum TB, DB and ATL concentrations, allevia- ting symptoms and improving life quality.