清胆合剂对胆总管切开取石术后患者胆汁、肝功能的影响

Effect of Qingdan Mixture on the Bile and Liver Function of Patients after Laparoscopic Common Bile Duct Exploration

【目的】观察清胆合剂对行腹腔镜下胆总管切开取石术后患者胆汁、肝功能的影响。【方法】将36例肝胆湿热型胆总管结石患者随机分为对照组和观察组,每组各18例。2组患者均行腹腔镜下胆总管切开取石术,对照组术后予西医常规治疗,观察组在对照组的基础上给予口服清胆合剂治疗,疗程为8 d。观察2组患者术后第1天、第4天、第8天胆汁引流量、胆汁成分(包括总胆红素、直接胆红素、间接胆红素、钙离子、胆固醇含量)及肝功能[包括谷氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆汁酸、直接胆红素]的变化情况。【结果】(1)胆汁引流量方面:观察组患者术后的胆汁总引流量为(2701.94±621.20)mL,明显高于对照组的(2188.94±788.10)mL,差异有统计学意义(P<0.05)。(2)胆汁成分方面:术后第4天和第8天,2组患者的胆汁总胆红素、间接胆红素和直接胆红素含量及观察组的胆汁胆固醇含量均较术后第1天明显降低,差异均有统计学意义(P<0.05或P<0.01);而2组患者术后各观察时点的胆汁钙离子含量比较,差异均无统计学意义(P>0.05)。(3)肝功能方面:术后第4天和第8天,2组患者血清AST和ALT含量均较术后第1天明显下降,其中除对照组术后第4天的血清AST含量外,差异均有统计学意义(P<0.05或P<0.01);而2组患者术后各观察时点的血清总胆汁酸和直接胆红素含量比较,差异均无统计学意义(P>0.05)。【结论】对于肝胆湿热型胆总管结石术后患者,给予清胆合剂治疗,可有效改善胆汁致石性成分,促进肝脏功能修复,对预防术后结石复发有一定的疗效。

Objective To observe the effect of Qingdan Mixture on the bile and liver function in patients after laparoscopic common bile duct exploration(LCBDE).Methods Thirty-six patients with choledocholithiasis of liver and gallbladder damp-heat syndrome type were randomly divided into the control group and the observation group,18 cases in each group.Both groups were treated with LCBDE,and then the control group was treated with postoperative conventional western medicine while the observation group was given oral use of Qingdan Mixture together with post operative conventional western medicine.The treatment for both groups lasted for 8 days.The changes in the bile drainage volume,bile composition(including the indicators of total bilirubin,direct bilirubin,indirect bilirubin,calcium ions,cholesterol content)and liver function[including the indicators of alanine transaminase(ALT),aspartate aminotransferase(AST),total bile acid,direct bilirubin]of the patients in the two groups were observed on postoperative day one,4 and 8.Results(1)The total volume of bile drainage in the observation group was(2701.94±621.20)mL,which was significantly higher than that in the control group[(2188.94±788.10)mL],and the difference was statistically significant(P<0.05).(2)Bile composition:on postoperative day 4 and 8,the contents of total bilirubin,indirect bilirubin and direct bilirubin in the bile of the two groups and the bile cholesterol content in the observation group were significantly lower than those on postoperative day one,and the differences were statistically significant(P<0.05 or P<0.01).However,the difference of bile calcium ion content at each postoperative observation time point was not statistically significant between the two groups(P>0.05).(3)Liver function:on postoperative day 4 and 8,the levels of serum AST and ALT in both groups were significantly decreased compared with those on postoperative day one,and the differences were statistically significant except for the serum AST level on postoperative day 4 in the control group(P<0.05 or P<0.01).The differences of serum total bile acid and direct bilirubin contents at each postoperative observation time point were not statistically significant between the two groups(P>0.05).Conclusion For the postoperative patients with choledocholithiasis of liver and gallbladder damp-heat syndrome type,the administration of Qingdan Mixture can effectively improve the lithogenic component of bile and promote the repair of liver function,which is effective on preventing the recurrence of cholelithiasis after operation.