胆道闭锁患儿术后的中药干预治疗

Traditional Chinese Medicine on Biliary Atresia in Children after Operation

目的探讨胆道闭锁(BA)术后患儿中药干预治疗的效果。方法28例BA术后患儿依据治疗过程中是否加用中药汤剂分为2组,在西药利胆保肝治疗基础上,一组加用中药治疗,一组单用西药,2组患儿平均手术日龄、治疗前胆红素水平经统计学处理均无显著性差异。治疗3个月后观察二组黄疸消退情况和治疗期间胆管炎发生次数,并对加中药组进行随访。结果临床退黄疗效比较,总有效率加中药组为77.8%,单纯西药组为40.0%,加中药组疗效优于单纯西药组(χ2=4.271P=0.039)。2组治疗后总胆红素均有下降,二组比较加中药组明显优于西药组(t=-2.847P=0.009)。治疗期间2组患儿胆管炎发生次数经统计学分析无显著性差异(t=0.318P=0.753),但发生胆管炎后加用中药组黄疸消退较快。对18例加用中药组患儿门诊随访2～6a,14例自体肝存活>3a者中7例肝功能轻度异常,ALT在70IU/L左右,有肝纤维化,但无明显脾功能亢进。西药组随访6个月,2例无黄疸存活,5例黄疸未消退,2例放弃治疗,1例死亡。结论BA术后患儿黄疸的消退、胆管炎的防治是内科治疗和调理的关键,加用中药有利于黄胆的消退,对胆管炎的治疗有协同作用,可作为BA术后患儿利胆保肝治疗方法之一。

Objective To explore the curative effect of traditional Chinese medicine on biliary atresia （BA） in children after operation.Methods Twenty-eight cases were divided into 2 groups.All children were treated with hepatoprotective and choleretic Western medicine.One group were given traditional Chinese medicine,and the other group were only treated with Western medicine.There was no statistical difference either in the average operation days or in preoperative bilirubin levels in both groups.After a period of 3-month treatment,jaundice,and frequency of cholangis were analyzed.Follow-up was done to the group with Chinese medicine.Results For jaundice,total efficiency were 77.8% in the group with additional Chinese medicine and 40.0% in the other group treated with Western medicine only.The group with Chinese medicine showed better outcome（χ^2=4.271 P=0.039）.The comparison of total bilirubin levels between 2 groups showed prominent difference（t=-2.847 P=0.009）,the group with Chinese medicine showed better outcome than that in other group.Cholangtis had happened during treatment in both groups,but no statistical difference was observed（t=0.318 P=0.753）,howe-ver,jaundice was alleviated earlier in group with Chinese medicine.Among the 18 children（with Chinese medicine group）,with follow-up period ranging from 2 to 6 years,14 children live for more than 3 years with their livers,although 7 cases of them had mild abnormal liver function,with glutamic-pyruvic transaminase （ALT around 70 IU/L）.They had liver fibrosis but they had no significant hypersplenism.Western medicine group were followed up for 6 months,of whom 2 cases were alive and free from jaundice,jaundice did not subside in 5 cases,1 patient died and 2 patients gave up treatment.Conclusions The cure of jaundice and the prevention of cholangis are crucial to the children with BA,Chinese medicine is helpful to alleviate the jaundice symptoms,and to cure the cholangitis.Therefore,it can be used as one of the methods for protecting the liver and relieving the jaundice for children with BA after operation.