茵陈蒿汤加减治疗湿热内蕴型胆肠Roux-en-Y吻合术后逆行性胆道感染的疗效分析

Therapeutic effect of modified Yinchenhao Decoction on retrograde biliary tract infection with damp-heat type after Roux-en-Y cholangiojejunostomy

目的:观察茵陈蒿汤加减对湿热内蕴型胆肠Roux-en-Y吻合术后逆行性胆道感染的临床疗效。方法:筛选2016年1月至2022年5月于河南省中医院/河南中医药大学第二附属医院行胆肠Roux-en-Y吻合术并术后发生逆行性胆道感染的患者42例,随机分为对照组(26例)和观察组(16例)。对照组单纯西医抗感染治疗,观察组在对照组基础上加用茵陈蒿汤加减治疗,比较两组在抗炎、退黄、症状缓解时间和抗菌总疗程等方面的差异,同时对发生反复胆道感染的可能因素进行Logistic回归分析。结果:治疗第3天,观察组白细胞、C-反应蛋白、降钙素原、总胆红素值较对照组显著降低(P<0.05),症状缓解时间和抗菌疗程时间显著缩短(P<0.05),吻合口直径是术后发生反复胆道感染的独立危险因素(P<0.05)。结论:在抗感染治疗基础上联合应用茵陈蒿汤加减对治疗胆肠Roux-en-Y吻合术后逆行性胆道感染具有积极作用,选择适宜的胆肠吻合口直径对避免术后反复胆道感染具有重要意义。

Objective:To observe the clinical effect of Yinchenhao Decoction on retrograde biliary tract infection(dampheat type)after Roux-en-Y cholangiojejunostomy.Methods:A total of 42 patients with retrograde biliary tract infection after Roux-en-Y cholangiojejunostomy in Henan Province Hospital of TCM/The Second Affiliated Hospital of Henan University of Chinese Medicine from January 2016 to May 2022 were screened,and were randomly divided into control group(26 cases)and observation group(16 cases).The control group was treated with simple anti infection treatment,and the observation group was treated with Yinchenhao Decoction on the basis of the control group.Then,the differences between the two groups in anti-inflammatory,removing jaundice,symptom relief time and total antimicrobial course were compared.In addition,Logistic regression analysis was performed on the possible factors of recurrent biliary tract infection.Results:On the third day after treatment,the white blood cell,C-reactive protein,procalcition and total bilirubin values of the observation group were lower than those of the control group(P<0.05),and the symptom relief time and the total antimicrobial course time were shorter(P<0.05).The diameter of cholangiojejunostomy was an independent risk factor for recurrent biliary tract infection(P<0.05).Conclusion:On the basis of anti infection treatment,combined use of the modified Yinchenhao Decoction has a positive effect on the treatment of retrograde biliary tract infection after Roux-en-Y cholangiojejunostomy. The appropriate anastomotic diameter of bile duct and jejunum is of great significance to avoid repeated postoperative biliary tract infection.