内镜联合中药治疗原位肝移植术后吻合口狭窄合并梗阻性黄疸

Endoscopic Retrograde Cholangiography Combined With Traditional Chinese Medicine Treating Obstructive Jaundice Caused by Biliary Stricte After Orthotopicliver Transplantation

目的:观察内镜联合中药治疗原位肝移植术后吻合口狭窄合并梗阻性黄疸的有效性。方法:对原位肝移植术后吻合口狭窄合并梗阻性黄疸的病人进行了56例次的内镜治疗,治疗组在内镜治疗后联合服用疏肝利胆退黄方;对照组单纯接受内镜治疗。治疗后定期复查血液分析和肝功能,计算黄疸日均下降值,并依据结果判定疗效。对合并有胆管结石的病人进行随访1年。结果:治疗组和对照组治愈率分别为75.0%和60.0%,总有效率分别为97.2%和90.0%,两组比较,差异有均统计学意义(P<0.05)。治疗组黄疸指标(总胆红素和直接胆红素)日均下降值较对照组下降更快,且统计学显示有显著差异(P<0.05)。32例次合并有胆管结石中,有22例口服中药,10例未服用,1年内治疗组和对照组各有4例复发胆管结石,复发率分别为18.2%和40%,两组的复发率有显著统计学差异(P<0.05)。结论:内镜联合疏肝利胆退黄方治疗原位肝移植术后胆管狭窄合并梗阻性黄疸有效,且能更快恢复黄疸,并且减少胆管结石复发。

Objective ：To observe the efficacy of endoscopic retrograde cholangiography （ERCP） combined with traditional Chinese medicine on obstructive jaundice caused by biliary stricte after orthotopicliver transplantation. Methods ： Patiens with biliary stricture after orthotopicliver transplantation from Jan. 2006 to Dec. 2009 were treated with ERCP and divided into two groups. The patients were treated with ERCP combined with traditional Chinese medicine in the treatment group and were treated with ERCP only in the control group. During and after treatment, we check blood analysis and liver function regularly. The patients incorporated Calculus of bile duct were followed up for 1 year. Results ： The total effective rate and the recovery rate of the treatment group were 97.2% and 75% respectively,which was higher than that of the control group（ 90.0% and 60% ） , （P 〈0. 05）. The improving of total bilirubin and direct bilirubin in treatment group was faster than that of control group（ P 〈 0. 05 ）. There were 4 patients incorporated Calculus of bile duct recurred in treatment group and control group respectively, the recurred rate were 18. 2% and 40% respectively（P 〈 0. 05 ）. Conclusion： ERCP combined with traditional Chinese medicine treating obstructive jaundice caused by biliary stricte after orthotopicliver transplantation is safe and effective.