内镜下治疗肝内外胆管结石1478例回顾性分析——对中药联合内镜治疗肝内外胆管结石的研究

Retrospective Analysis of Endoscopy on 1478 Cases with Intra-and Extrahepatic Bile Duct Stone-Research of Traditional Chinese Medicine Herb Combination with Endoscopy on Intra-and Extrahepatic Bile Duct Stone

目的回顾性分析中药联合内镜治疗肝内外胆管结石临床疗效。方法分析本院既往5年肝内外胆管结石患者。分为中药组及非中药组。比较两组患者黄疸入院术前和出院前最后1次检测水平,并计算日均黄疸下降值、人均住院日。对未能一次性取石成功者,应分析其原因,记录进一步处理办法。对随访1年的病例,记录复发情况。观察内镜治疗情况和中药联合内镜治疗情况,并观察患者治疗效果,对成功取石后出院、既往有胆道手术史的病例随访。结果 1410例一次性取石成功,一次性取石成功率为95.40%。946例术后联合口服清胰利胆退黄方,治疗后中药组住院天数短于非中药组,黄疸指数的日均下降数值亦高于非中药组;未能一次性取净结石的68例难治性结石,除其中18例直接内镜下胆管支架引流术放置胆道塑料支架外,其余均经鼻胆管中药溶石后取净结石。中药组391例1年内复发9例(2.30%),非中药组283例1年内复发18例(6.36%),中药组复发率显著低于非中药组。结论内镜下治疗肝内外胆管结石联合口服中药,近期可促进肝功的恢复、减少住院日,远期可预防或延缓结石的复发。对于难治性胆管结石不能一次性取石成功者,联合经鼻胆管注入溶石中药,可提高取石的成功率。

Objective：To make a retrospective analysis of 1478 cases with intrahepatolithiasis and extrahepatic bile duct stone disease treated with therapeutic endoscopy and the traditional chinese medicin（TCM）on promoting recovery of liver function,reducing the time of hospitalization and preventing stone to recur.Methods： Complete clinical data of 1478 cases were collected from March 2004 to March 2009 in department of traditional chinese medicine of Shenyang military region general hospital.To analysis the information of cases treated with therapeutic endoscopy and combinated with the TCM,to observe the therapeutic efficacy.The cases that removing calculus succeed and had the history of operation on biliary tract were followed up for 1 year.Results： 1410 cases were removing calculus 1 times,achievement ratio was 95.40%.946 cases were combinated with Qingyilidantuihuang Decoction.After treatment,the time of hospitalization in the group of TCM was shorter than the group of non-TCM.The numerus of icteric index decreasing daily in the group of TCM were higher than the group of non-TCM.In 68 cases with refractory stone,18 cases were ERBD,the other 50 cases injected TCM decoction through nasobiliary drainage and removing calculus succed in the end.The recurrence rate of the group of TCM（2.30%） was lower than the group of non-TCM＇s（6.36%） significantly.Conclusion： After the treatment of endoscopy,the cases that combinated with TCM can promote the liver function as soon as possible and reduce the time of hospitalization in the near future.It can prevent or delay the recur of calculus in long-time.Injecting TCM decoction through nasobiliary drainage to dissolve stone for refractory stone can increase the achievement ratio of removing stone.