利肝化湿保胆散与熊去氧胆酸联合应用对胆管结石患者术后肝功能及复发率的影响评价

Impact Evaluation of Ligan Huashi Baodan Powder and Ursodeoxycholic Acid Joint Application on Postoperative Liver Function and Recurrence Rate for Patients with Bile Duct Stones

目的:评价利肝化湿保胆散与熊去氧胆酸联合应用对胆管结石患者术后肝功能及复发率的影响。方法:选取2019年1月~2021年1月四川省岳池县人民医院收治的胆管结石患者98例,所有患者均行腹腔镜下胆总管切开取石术治疗,采用掷硬币法分为两组,各49例。对照组术后给予熊去氧胆酸治疗,观察组术后给予利肝化湿保胆散与熊去氧胆酸联合治疗。比较两组住院时间、T管引流量、不良反应和复发率,检测两组胆汁中糖蛋白(GP)含量和血清中肝功能指标的变化。结果:观察组住院时间短于对照组,差异有统计学意义(P<0.05)。两组在术后2d、7d、14d时T管引流量比较,差异无统计学意义(P>0.05),对照组术后28d的T管引流量低于术后2d,且同时低于同时期观察组,差异有统计学意义(P<0.05)。术后7d、14d、28d时两组胆汁中GP含量均术后2d升高(P<0.05)。与对照组比较,观察组术后14d、28d时胆汁中GP含量明显更低(P<0.05)。3个月后,两组天冬氨酸转氨酶(AST)、谷丙氨酸转氨酶(ALT)、总胆红素(TBil)较治疗前降低,总胆汁酸(TBA)较治疗前升高(P<0.05)。与对照组比较,观察组3个月后的AST、ALT、TBil明显更低,TBA明显更高(P<0.05)。两组在轻微腹泻、恶心呕吐、疲倦乏力、胃痛等不良反应方面比较,差异无统计学意义(P>0.05)。观察组半年内复发率低于对照组,差异有统计学意义(P<0.05)。结论:利肝化湿保胆散联合熊去氧胆酸治疗胆管结石患者术后有利于肝功能的恢复,降低胆汁中GP的表达,减少复发。

Objective:To evaluate the effect of combined application of Ligan Huashi Baodan Powder and ursodeoxycholic acid on the postoperative liver function and recurrence rate of patients with bile duct stones.Methods:A total of 98 patients with bile duct stones admitted to our hospital from January 2019 to January 2021 were selected.All 98 patients underwent laparoscopic choledochectomy and stone removal.They were divided into two groups by tossing a coin,each group with 49 cases.The controlled group was treated with Ursodeoxycholic Acid after the operation,and the observation group was treated with Ligan Huashi Baodan Powder combined with Ursodeoxycholic Acid after the operation.The length of hospital stay,T tube drainage,adverse reactions and recurrence rates were compared between the two groups,and changes in the levels of glycoprotein(GP)in bile and liver function indexes in serum were detected.Results:The length of hospital stay in the observation group was shorter than that in the controlled group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in T tube drainage between the two groups at 2 d,7 d,and 14 d after surgery(P>0.05).The T tube drainage at 28 d postoperatively in the controlled group was lower than that at 2 d postoperatively and at the same time was lower than that of the same period.In the observation group,the difference was statistically significant(P<0.05).The GP content in bile of both groups increased on the 7th,14th,and 28thday after operation(P<0.05).Compared with the controlled group,the GP content in the bile of the observation group was significantly lower at 14 d and 28 d after operation(P<0.05).After 3 months,the two groups of aspartate aminotransferase(AST),glutalanine aminotransferase(ALT),total bilirubin(TBil)were lower than before treatment,and total bile acid(TBA)was higher than before treatment(P<0.05).Compared with the controlled group,the observation group’s AST,ALT,and TBIL were significantly lower after 3 months,and the TBA was significantly higher(P<0.05).There was no statistically significant difference between the two groups in terms of adverse reactions such as mild diarrhea,nausea and vomiting,fatigue,and stomach pain(P>0.05).The recurrence rate in the observation group was lower than that in the controlled group within six months,which was statistically significant(P<0.05).Conclusion:The combination of Ligan Huashi Baodan Powder and Ursodeoxycholic Acid in the treatment of bile duct stones after surgery is beneficial to the recovery of liver function,reducing the expression of GP in bile and reducing recurrence.