茵虎利胆合剂配合鼻胆管引流治疗阻塞性黄疸30例

Yinhu cholagogue mixture combined with endoscopic naso-biliary drainage in treatment of patients with obstructive jaundice: an analysis of 30 cases

目的:观察茵虎利胆合剂配合鼻胆管引流术(ENBD)治疗阻塞性黄疸的临床效果,并探讨其作用机制.方法:将90例阻塞性黄疸患者随机分成手术对照组、内镜对照组以及茵虎实验组各30例手术组行传统开放手术治疗;内镜组行ENBD治疗,实验组给予ENBD+茵虎利胆合剂治疗观察各组患者T管、鼻胆管引流情况,同时监测90例患者术前、术后7、14d的血清TBIL、DBIL、AKP、GPT、GOT、LPS的变化和手术前后IL-6水平变化.结果:术后第14天各组患者血清LPS、IL-6、TBIL、DBIL、AKP、GPT、GOT较术前均显著下降(P<0.05或0.01),且茵虎实验组明显低于手术及内镜对照组(0.07±0.01vs0.12±0.03,0.13±0.03;166.5±31.62vs230.2±41.08,225.6±42.69;24.3±7.91vs43.3±9.4946.7±11.07;12.6±4.74vs32.2±6.33,46.7±11.07;67.5±25.30vs102.5±36.37,114.9±39.53;36.8±14.23vs79.0±35.88,82.3±34.79;46.2±11.07vs84.5±34.79,80.3±31.62,P<0.05或0.01),手术对照组及内镜对照组间无显著性差异;术后5d始茵虎实验组胆汁引流水平明显高于手术及内镜对照组(P<0.05或0.01),而手术与内镜对照组间无显著性差异.结论:茵虎利胆合剂配合鼻胆管引流可以有效地治疗阻塞性黄疸,促进胆汁排泄,降低LPS和IL-6.

AIM： To observe the clinical efficacy and mechanism of Yinhu cholagogue mixture （YCM） combined with endoscopic naso-biliary drainage （ENBD） in the treatment of patients with obstructive jaundice （OJ）. METHODS： A total of 90 OJ patients were ran- domly divided into surgery control group （n = 30）, endoscopy control group （n = 30） and YCM group （n = 30）, treated with traditional open surgery, ENBD alone and YCM plus ENBD, respectively. We observed the T-tube and naso-biliary drainage situation, while monitored the serum TBIL, DBIL, AKP, GPT, GOT, LPS and IL-6 levels before and after operation. RESULTS： On the 14th day after sugery, LPS, IL-6 levels and the liver function markers such as TBIL, DBIL, AKP, GPT and GOT in all the patients decreased obviously, and these indexes were markedly lower in YCM group than those in the surgery control group and endoscopy control group （0.07 ± 0.01 vs 0.12± 0.03, 0.13 ± 0.03; 166.5 ± 31.62 vs 230.2 ± 41.08, 225.6 ± 42.69; 24.3 ± 7.91 vs 43.3 ± 9.49, 46.7 ± 11.07; 12.6 ± 4.74 vs 32.2 ± 6.33, 46.7 ± 11.07; 67.5 ± 25.30 vs 102.5 ± 36.37, 114.9 ± 39.53; 36.8 ± 14.23 vs 79.0 ± 35.88, 82.3 ± 34.79; 46.2 ± 11.07 vs 84.5 ± 34.79, 80.3 ± 31.62, respectively; P 〈 0.05 or 0.01）; there were no marked differences between the two control groups. On the 5th day after operation, combined therapy was superior to the other two treatments in bile drainage （P 〈 0.05 or 0.01）, but there was no significant difference between the two control groups. CONCLUSION： YCM in combination with ENBD can effectively restore liver function, promote bile excretion and lower LPS and IL-6 levels in OJ patients.