双镜联合十二味疏肝利胆冲剂治疗肝外胆管结石的临床疗效

目的 观察腹腔镜、胆道镜双镜联合十二味疏肝利胆冲剂治疗肝外胆管结石的临床疗效。方法 选取安徽中医药大学第一附属医院普外科2013年1月至2016年12月住院的肝外胆管结石患者48例，按照随机数字表法，将患者分为研究组与对照组，每组24例。对照组采用腹腔镜、胆道镜双镜联合手术，术后常规治疗；研究组在对照组的基础上，应用十二味疏肝利胆冲剂。比较两组患者的临床疗效和住院指标、血常规、胆汁生化、肝功能胆汁引流量及术后复发率。结果 对照组患者总有效率91.67%，研究组总有效率为95.83%，两组差异无统计学意义（P>0.05）。研究组术后胃肠功能恢复时间、进食时间、住院时间，均优于对照组，差异有统计学意义（P<0.05），两组患者治疗前后血常规指标、肝功能指标、血清胆汁生化指标比较，两组差异有统计学意义（P<0.05）。研究组术后第5、7天胆汁引流量分别为（669.10±113.65）和（860.53±126.26）mL，均高于对照组，两组差异有统计学意义（P<0.05）。随访12个月，研究组复发率（4.17%）低于对照组（12.50%），差异有统计学意义（P<0.05）。结论 双镜联合十二味疏肝利胆冲剂口服可提高腹腔镜胆道探查联合术中胆道镜手术的成功率，较好的控制术后胆管炎症，促进肝功能快速恢复，减少术后并发症，防治结石复发。

Clinical observation of treatment of extrahepatic bile duct stones with double mirror combined with Shugan Lidan granules composed of twelve traditional Chinese medicine

Objective To observe the clinical efficacy and safety of laparoscopy and choledochoscopy combined with Shugan Lidan granules composed of twelve traditional Chinese medicine in the treatment of extrahepatic bile duct stones. Methods Forty-eight cases of extrahepatic bile duct stones who were admitted to this hospital from Jan 2013 to Dec 2016 were divided into the study group and the control group according to the randomized controlled trial, with 24 cases in each group. The control group was treated with double mirror combined therapy, namely laparoscopic common bile duct exploration and intraoperative choledochoscopy for exploration and removal. On the basis of the control group''s treatment, the study group was given Shugan Lidan granules composed of twelve traditional Chinese medicine. After treatment, the clinical efficacy and related indexes of the two groups were observed. Results In the comparison of the clinical effects of two groups, the total effective rate of control group was 91.67%, that of study group was 95.83%, and there was no statistically significant difference(P>0.05). The recovery time of gastrointestinal function in study group was(24.72±4.13)h, eating time(33.14±4.91)h and hospitalization time(8.16±2.35)d, which were significantly shorter than those in control group(P< 0.05). In two groups of patients before and after treatment, the differences in blood routine indicators, liver function indicators, serum bile biochemical indicators between the two groups were statistically significant(P<0.05). The bile flow rate of study group was(669.10±113.65) mL and(860.53±126.26) mL on 5th d and 7th d, respectively, which was significantly higher than that in control group. The difference between two groups was statistically significant(P<0.05). After 12 months of follow-up, the recurrence rate of study group(4.17%) was significantly lower than that of control group(12.50%)(P<0.05). Conclusion Laparoscopy and choledochoscopy combined with Shugan Lidan granules composed of twelve traditional Chinese medicine can improve the success rate of operation, have better control of postoperative biliary inflammation, promote rapid recovery of liver function, reduce postoperative complications, and prevent recurrence of stones.