疏肝利胆汤预防胃癌根治术后胆囊结石的临床研究

Clinical study on Shugan Lidan Decoction in preventing gallstones after radical total gastrectomy

目的探讨疏肝利胆汤对预防胃癌根治术后胆囊结石形成的疗效。方法选取2016年1-12月期间浙江省肿瘤医院腹部外科行胃癌根治术的120例患者,且术前行超声检查排除胆道系统疾病(包括胆囊炎症、胆囊或胆管结石等),除外糖尿病等可能影响胆囊排空功能的疾病。将120例患者按随机数字表法分为观察组和对照组,各60例。2组术后均给予常规治疗,观察组于术后第10天开始每天1贴,分2次给予疏肝利胆汤200 mL口服,连续服用20 d。观察2组患者胃肠道反应情况。2组患者术前3 d和术后30 d测空腹胆囊收缩素浓度,超声测量空腹及脂肪餐后胆囊容积,计算胆囊排空率。随访观察2组患者胆囊结石发生情况。结果 2组患者胃肠道反应发生率相近,差异无统计学意义。术后观察组和对照组血清CCK含量均有升高,观察组CCK含量明显高于对照组,差异有统计学意义(P<0.05)。术后观察组和对照组胆囊排空率均较术前下降,但观察组胆囊排空率高于对照组,差异有统计学意义(P<0.05)。25例(20.8%)患者发生胆囊结石,其中观察组8例(13.3%),对照组17例(28.3%),差异有统计学意义(χ~2=4.093,P=0.043)。结论疏肝利胆汤可以改善胃癌根治术后胆囊排空功能,降低胆囊结石的发生率。

Objective To explore the efficacy of Shugan Lidan Decoction in preventing gallstone after radical total gastrectomy. Methods From January to December 2016, 120 patients with gastric cancer underwent radical total gastrectomy in the Department of Abdominal Surgery in Zhejiang Cancer Hospital were selected. Preoperative ultrasonography was performed to exclude diseases of biliary system(including gallbladder inflammation, gallbladder or bile duct stones). Patients with diabetes, which may affect gallbladder emptying function, were also excluded. The patients were divided into experimental group and control group according to random number table, 60 cases in each group. Routine treatment was given in both groups after operation. The experimental group was given Shugan Lidan Decoction 200 ml orally for 20 days from the 10 th day after operation. The gastrointestinal reactions of the two groups were observed. The concentration of cholecystokinin was measured 3 days before operation and 30 days after operation. The volume of gallbladder was measured by ultrasound and the emptying rate of gallbladder was calculated. The occurrence of cholecystolithiasis in the two groups was observed. Results The incidence of gastrointestinal reactions was similar between the two groups, and there was no significant difference. After operation, the serum CCK content in the two groups were increased, but it in the experimental group was significantly higher than that in the control group(P<0.05). The gallbladder emptying rate of the two groups were decreased after operation, but the emptying rate of the experimental group was higher than that of the control group(P<0.05). Cholecystolithiasis occurred in 25 patients(20.8%) including 8 in the experimental group(13.3%) and 17 in the control group(28.3%), with the statistically significant difference(χ~2=4.093, P=0.043). Conclusion Shugan Lidan Decoction can improve the gallbladder emptying function and reduce the incidence of gallstones after radical total gastrectomy.