疏肝理气清热利胆法对胆管结石术后患者胆汁糖蛋白含量的影响

Effect of Therapy of Soothing Liver and Regulating Qi,Clearing Heat and Promoting Bile Secretion on Bile Glycoprotein of Postoperative Patients with Bile Duct Stones

【目的】运用疏肝理气、清热利胆法治疗胆管结石术后患者,观察其对胆汁糖蛋白含量的影响,为中医药治疗和预防胆管结石复发提出思路和方法。【方法】将60例胆管结石行腹腔镜下胆总管切开取石术+T管引流术+胆囊切除术后患者,随机分为试验组与对照组,每组各30例。试验组给予疏肝理气、清热利胆法中药干预4周,对照组不予药物干预。观察2组患者治疗前后T管引流量、胆汁糖蛋白含量和比值的变化情况。【结果】(1)2组患者不同时间点T管引流量比较,差异有统计学意义(P<0.001),组间与时间有交互作用(P<0.01),治疗后4周开始,治疗组的T管引流量明显高于对照组,差异均有统计学意义(P<0.001)。(2)2组患者组间及不同时间点胆汁糖蛋白含量和比值比较,差异均有统计学意义(P<0.01或P<0.001),组间与时间有交互作用(P<0.01或P<0.001)。随着干预时间的延长,对照组患者胆汁糖蛋白含量和比值逐渐升高,治疗组胆汁糖蛋白含量和比值稍升高后逐步降低,于治疗后2、3、4周,治疗组的胆汁糖蛋白含量和比值均明显低于对照组,差异均有统计学意义(P<0.05或P<0.01或P<0.001)。【结论】疏肝理气、清热利胆法对胆管结石术后患者的胆汁糖蛋白含量及比值具有降低作用,这可能是其减少胆管结石术后复发的机制之一。

Objective To study the effect of therapy of soothing liver and regulating Qi,clearing heat and promoting bile secretion on bile glycoprotein of postoperative patients with bile duct stones,thus to provide thoughts and methods for the treatment and prevention of recurrence of bile duct stones with Chinese medicine.Methods Sixty patients with bile duct stones who received choledocholithotomy+T-tube drainage+cholecystectomy under laparoscope were randomly divided into trial group and control group,30 cases in each group.The trial group was given oral use of Chinese medicine with the actions of soothing liver and regulating Qi,clearing heat and promoting bile secretion for 4 weeks,and the control group was not given any drug intervention.Before and after treatment,the volume of T-tube drainage,and the content and proportion of bile glycoprotein in the two groups were observed.Results(1)The differences of the volume of T-tube drainage in the two groups at various time points were significant(P<0.001),and there existed the interaction between groups and time(P<0.01).From the fourth week of the treatment with Chinese medicine,the volume of T-tube drainage in the trial group was obviously increased as compared with that in the control group,the difference being significant(P<0.001).(2)The differences of the content and proportion of bile glycoprotein in the two groups at various time points were significant(P<0.01 or P<0.001),and there existed the interaction between groups and time(P<0.01 or P<0.001).With the prolongation of the medication time,the content and proportion of bile glycoprotein in the control group were increased gradually,and those in the trial group were mildly increased firstly and then were decreased gradually;2,3,4 weeks after treatment with Chinese medicine,the content and proportion of bile glycoprotein in the trial group were much lower than those in the control group,the difference being significant(P<0.05 or P<0.01 or P<0.001).Conclusion Therapy of soothing liver and regulating Qi,clearing heat and promoting bile secretion can reduce the content and proportion of bile glycoprotein in postoperative patients with bile duct stones,which may be one of the mechanisms in preventing the recurrence of bile duct stones.