李月廷教授防治保胆取石术后结石复发的临床经验

Clinical experience of professor Li Yueting in preventing and treating stone recurrence after gallbladder-preserving cholecystolithotomy

微创保胆取石术后存在一定的结石复发率。李月廷教授认为术后结石复发,病位主要在肝胆,与脾、胃、肠等脏腑相关,病机与肝胆疏泄失司、脾胃升降失调、胆肠腑气失通相关。临床诊治以疏肝利胆、行气通腑为本,辅以调和脾胃,活血化瘀。遣方用药时,既注重“肝”治疗疏肝为先之法的运用,又注重“胆”的治疗,从胆论治以护胆,还注重“肠”的治疗,即认为“泄肠亦利胆”,意在疏通胆汁排泄,获得临床疗效。

There is a certain rate of stone recurrence after minimally invasive gallbladder-preserving cholecystolithotomy.Professor Li Yueting believes that the location of the stone recurrence after gallbladder-preserving cholecystolithotomy is mainly in the liver and gallbladder,and it is related to spleen,stomach,intestines and other viscera.Its pathogenesis is related to the failure to distribute freely of liver and gallbladder,abnormal ascension and descension of spleen and stomach,fuqi obstruction of gallbladder and intestines.Clinic treatment is mainly consisted of dispersing stagnated liver qi for promoting bile flow,activating qi and purging fu organs,combined with the methods of reconciling spleen and stomach,promoting blood circulation and removing blood stasis.When making formula and description,he not only pays attention to the application of“liver”treatment for liver-discharging first,but also to the treatment of“gallbladder”for the purpose of protecting the gallbladder,and to the treatment of the“intestines”,which is intended to clear the bile excretion from the clinical experience that“the intestinal excretion is also the bile drain”,and thus achieve its clinical effects.