大柴胡汤加减联合ERCP治疗肝胆湿热证胆总管结石急性发作的疗效分析

Effect of Dachaihu Decoction(大柴胡汤)Combined with ERCP in Treatment of Acute Attack o Choledocholithiasis with Syndrome of Damp-heat in Liver and Gallbladder

目的探讨内镜逆行性胰胆管造影术(ERCP)联合大柴胡汤治疗肝胆湿热证胆总管结石的临床效果。方法收集自2014年8月—2017年8月在该院消化内科住院的87例胆总管结石患者,按随机数字表法将患者分为联合组43例患者,对照组44例。对照组给予常规对症治疗及ERCP内镜微创,联合组在对照组的基础上给予大柴胡汤加减治疗,疗程为4 d。记录两组患者的操作治疗的一般情况(一次性完成、二次操作、治疗失败、转外科手术以及塑料支架置入引流的病例)、中医证候积分、肝功能主要指标(血清丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、碱性磷酸酶、γ-谷氨酰基转移酶)、并发症或不良反应(腹痛、切口出血、术后感染、胰腺炎指标升高、呼吸衰竭、死亡)。应用SPSS 17.0软件对数据进行统计分析。结果中医证候疗效评价上,联合组总有效率(95.5%,42/44)优于对照组(86.0%,37/43)(P<0.01)。对于肝功能的主要指标的改善上,与治疗前相比,对照组和联合组治疗后血清丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、碱性磷酸酶、γ-谷氨酰基转移酶均得到了明显的改善(P<0.01)。在治疗后的两组组间比较中,联合组对于改善天门冬氨酸氨基转移酶和γ-谷氨酰基转移酶的效果明显的优于对照组(P<0.01)。并发症方面,两组均以腹痛最常见,分别为7例和8例。其次为胰腺炎指标(血清淀粉酶、血清脂肪酶)升高,分别为7例、8例。该研究无呼吸衰竭或死亡病例报告。结论 ERCP联合大柴胡汤治疗肝胆湿热证胆总管结石具有较好疗效。

Objective To discuss the clinical effect of ERCP combined with Dachaihu Decoction(大柴胡汤) treating choledocholithiasis with syndrome of damp-heat in liver and gallbladder.Methods A total of 87 patients with choledocholithiasis hospitalized in the Department of Digestive Medicine of our hospital from August 2014 to August 2017 were divided into the combined group(43 patients) and the control group(44 patients) according to the random number table method.The control group was given routine symptomatic treatment and ERCP endoscopic minimally invasive treatment.The combined group on the basis was given Dachaihu Decoction,and the course of treatment was 4 days.We recorded the general condition of the operation and treatment of the two groups(one-time completion,secondary operation,treatment failure,surgery transfer and plastic stent placement drainage cases),TCM syndrome score,main indexes of liver function(serum alanine aminotransferase,aspartate aminotransferase,total bilirubin,alkaline phosphatase,γ-glutamyltransferase),complications or adverse reactions(abdominal pain,incision bleeding,postoperative infection,elevated pancreatitis index,respiratory failure,death).SPSS 17.0 software was used for statistical analysis of the data.Results For the evaluation of TCM syndrome efficacy,the total effective rate(95.5%,42/44) of the combined group was better than that of the control group(86.0%,37/43)(P<0.01).On the improvement of the main indexes of liver function,compared with those before treatment,the serum alanine aminotransferase,aspartate aminotransferase,total bilirubin,alkaline phosphatase and γ-glutamyltransferase were significantly improved after treatment in the control group and the combined group(P<0.01).After treatment,the combined group′s were significantly better than those of the control group for improving aspartate aminotransferase and γ-glutamyltransferase(P<0.01).In terms of complications,the abdominal pain was the most common in both groups,7 and 8 cases,respectively.Secondly,the index of pancreatitis(serum amylase,serum lipase) was increased,7 and 8 cases respectively.No respiratory failure or death cases were reported in this study.Conclusion ERCP combined with Dachaihu Decoction had a good effect in the treatment of choledocholithiasis with syndrome of damp-heat in liver and gallbladder.