胆道排石合剂治疗肝内三级以上胆管结石42例临床分析

Effects of Dandao Paishi Mixture for the Treatment of the Third-level or Above Intrahepatic Biliary Duct Stone: An Observation of 42 Cases

[目的]探讨有疏肝利胆、清热祛湿、活血化瘀作用的中药在治疗肝内三级或三级以上胆管结石方面的优势。[方法] 对我院42例肝内外胆管结石患者采用常规胆囊切除+胆总管切开取石T管引流+胆道镜取石术配合中药胆道排石合剂(由金钱草、威灵仙、茵陈、广木香、姜黄、郁金、枳壳、柴胡、青皮等药物组成)口服治疗,观察中药治疗肝内三级或三级以上胆管结石的疗效。[结果]本组42例患者在服中药治疗前,三级或三级以上肝内胆管结石无法取出,服中药治疗后行经T管逆行胆道造影检查,发现有39例排尽结石,治愈率达92.9%;3例发现胆总管内残留结石,8周后采用Olympus纤维胆道镜经胆总管T管窦道取石,一次取尽。[结论]胆道排石合剂治疗肝内胆管结石尤其是三级或三级以上的和较大的嵌顿性肝内胆管结石,具有良好的溶石排石效果,利于结石的排出,并能减少术后结石残留,降低复发率。

[ Objective ] To investigate the therapeutic effect of Chinese herbal medicines, which have the actions of dispersing stagnated liver-Qi and promoting bile secretion, clearing heat and removing damp, activating blood and removing blood-stasis, in the treatment of the third-level or above intrahepatic biliary duct stone. [Methods] After the routine surgical treatment including cholecystectomy, choledochotomy with T-tube drainage and choledochoscope lithotomy, 42 cases of third-level or above intrahepatic biliary duct stone received Dandao Paishi Mixture (DPM, mainly composed of Herba Lysimachiae, Radix Clematidis, Herba Artemisiae Scopariae, Radix Aucklandiae, Rhizoma Curcumae Longae, Radix Curcumae, etc.) for oral use. The effects of DPM on the intrahepatic biliary duct stone were evaluated after treatment. [Results] Before the treatment of DPM, the stones in third-level or above intrahepatic biliary ducts cannot be taken out; after the treatment of DPM, T-tube reverse biliary contrast examination showed that stones were removed in 39 (92.9%) cases, stones still existed in the common bile duct in 3 cases and then were removed by lithotomy through T-tube sinus of the common bile duct with Olympus fiber choledochoscope 8 weeks later. [Conclusion] DPM has good lytholytic and lithagogue effects for the treatment of third-level or above intrahepatic biliary duct stone and for intrahepatic biliary duct incarcerated stone. It can also reduce the postoperative residue of stone and recurrence rate.