中药胆胰和胃冲剂对胆道内成石因素的影响和预防术后复发的效果

Effects of danyihewei granule on stone forming factors in biliary tract and prevention of postoperative stone formation

目的研究中药胆胰和胃冲剂对胆道内环境成石因素的影响，并观察其预防术后胆石形成的临床效果．方法Ⅰ组应用自制中药胆胰和胃冲剂（由柴胡、金钱草、大黄，黄芩等１１味中药组成），选择胆道手术后胆道置管引流患者３６例，服该冲剂者２２例为服药组，不服药１４例为对照组．动态观察服药前后引流胆汁组分的变化，另设１５例服药，１０例对照，观察胆汁中氧自由基的变化，从多因素研究该冲剂对胆道内环境成石胆汁的影响．Ⅱ组肝胆管结石手术后取净结石患者２２４例，分２组，服药组１３０例，不服药对照组１１４例，随访１ａ～８ａ，观察胆石复发情况．结果Ⅰ组：服药组２２例，胆汁中胆酸显著增高（ｍｇ／Ｌ，７７９±５３６→９５７±７８８），胆红素，粘蛋白显著降低（分别由μｍｏｌ／Ｌ，５５５±２７２→３７６±２０６；ｍｇ／Ｌ，１６０±５８→１４２±４１，Ｐ＜００１）．对照组无变化．服药组胆汁组分胆酸∶胆固醇（服药前７７９±５３６∶８７７±５８８，后９５７±７９０∶８５０±４５７）；胆酸∶胆红素的比值（服药前７７９±５３６∶５５５±２７２，后９５７±７９０∶３７２±２０６），均呈动态升高（Ｐ＜００１）．Ⅲ组１５例，对照分组１０例，检查胆汁中Ｏ－２与ＳＯＤ?

AIM To study the influence of danyihewei granule on stone forming factors of internal environment in biliary tract and on prevention of gallstone formation. METHODS Group 1: 36 patients with postoperative hepatolith and biliary drainage were divided into two groups: 22 patients receiving danyihewei granule which were composed of 11 sorts of Chinese herbs (mainly Chaihu, Jinjiancao, Dahuang, etc.); 14 patients as the control group. The elements of bile before and after taking the granule were analysed. In addition, oxygen radicals were detected in 15 patients administered the herbs and 10 patients in control group. Group 2: 244 patients, whose intrahepatic stones were cleared by operation, were divided into two sub groups: drug treated 130 cases (sub group 1); non drug treated 114 cases (sub group 2 as control). All patients were followed up for 1-8 years in order to find out recurrence of bile stones. RESULTS In drug treated group of group 1, the amount of cholic acid (CA) in bile was markedly increased ( mg/L , 779±536→957±788), while bilirubin (Bil) ( μmol/L ,555±272→376±206); and mucin ( mg/L ,160±58→142±41) were decreased ( P <0 01), but there was no change in control group. The ratio of CA to Bil and CA to cholesterol (Cho) all increased in drug treated group (CA:Bil 779±536∶555±272→957±790∶372±206; CA: Cho 779±536∶877±588→957±790∶850±457, P <0 01). O - 2 level in bile in 15 treated cases of group 2 was decreased (8814→3930), but SOD in bile was increased after taking herb(95→142, P <0 01), with marked difference between drug treated group and control group. The recurrence rate of bilestone in sub group 1 was 3 84% (5/130), and 27 9% in sub group 2 (31/114, P <0 01). CONCLUSION Chinese herb danyihewei granule can regulate internal environment of biliary tract, reverse stone forming bile and prevent stone recurrences.