熊去氧胆酸胶囊治疗肝内外胆管结石患者的临床研究

Clinical trial of ursodeoxycholic acid capsule in the treatment of patients with intrahepatic and extrahepatic bile duct stones

目的观察熊去氧胆酸胶囊联合腹腔镜辅助胆道镜取石术治疗肝内外胆管结石的临床效果。方法将肝内外胆管结石患者分为对照组和试验组。对照组给予腹腔镜辅助胆道镜取石术治疗,术后给予抗感染、保肝、营养支持等一般维持治疗,试验组在对照组基础上给予熊去氧胆酸胶囊0.25 g,tid,口服治疗,连续服用6个月。比较2组患者的症状消失率、肝功能指标[谷丙转氨酶(GPT)、谷草转氨酶(GOT)、总胆红素(TBIL)]、脂代谢指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)]和结石复发率,统计术后并发症发生情况。结果试验组和对照组分别纳入45和43例。治疗后,试验组和对照组的总有效率分别为95.56%(43例/45例)和81.40%(35例/43例),在统计学上差异有统计学意义(P<0.05)。术后6个月,试验组和对照组的上腹部疼痛消失率分别为95.56%(43例/45例)和81.40%(35例/43例),肝区压痛消失率分别为100.00%(45例/45例)和86.05%(37例/43例),血清GPT分别为(31.54±6.27)和(38.29±6.63)U·L^(-2),GOT分别为(38.75±5.52)和(43.46±5.08)U·L^(-1),TBIL分别为(26.57±6.39)和(32.28±7.61)μmol·L^(-1),TC分别为(5.29±1.06)和(6.12±1.03)mmol·L^(-1),TG分别为(1.45±0.43)和(1.69±0.46)mmol·L^(-1),HDL分别为(1.69±0.36)和(1.51±0.39)mmol·L^(-1),结石复发率分别为0(0例/45例)和11.63%(5例/43例),在统计学上差异均有统计学意义(均P<0.05)。试验组的药物不良反应主要有恶心、腹泻,对照组未发生药物不良反应。试验组和对照组的总药物不良反应发生率分别为6.67%(3例/45例)和0(0例/43例),在统计学上差异无统计学意义(P>0.05)。结论腹腔镜辅助胆道镜取石术后应用熊去氧胆酸胶囊可促进肝内外胆管结石患者临床症状、肝功能的改善,加速脂代谢,预防结石复发。

Objective To observe the clinical effect of ursodeoxycholic acid capsules combined with laparoscopic-assisted choledochoscopic lithotomy in the treatment of intrahepatic and extrahepatic bile duct stones.Methods Patients with intrahepatic and extrahepatic bile duct stones were divided into the control group and the treatment group.The control group was treated with laparoscopic-assisted choledochoscopic lithotomy,and was given general maintenance treatment after operation,such as anti infection,liver protection,and nutritional support.On this basis,the treatment group was treated with ursodeoxycholic acid capsules(0.25 g,tid,orally administration,for 6 months).The symptom disappearance rate,liver function indicators[glutamic-pyruvic transaminase(GPT),glutamic oxalacetic transaminase(GOT),total bilirubin(TBIL)],lipid metabolism indicators[total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL)]and stone recurrence rate were compared between the two groups.The incidence rates of postoperative complications were calculated.Results Forty-five cases were included in the treatment group and fortythree cases in the control group,respectively.After treatment,the total effective rates in the treatment group and the control group were 95.56%(43 cases/45 cases)and 81.40%(35 cases/43 cases)(P<0.05).Six months after surgery,the disappearance rates of upper abdominal pain in the treatment group and the control group were 95.56%(43 cases/45 cases)and 81.40%(35 cases/43 cases);the disappearance rates of hepatic tenderness were100.00%(45 cases/45 cases)and 86.05%(37 cases/43 cases);GPT levels were(31.54±6.27)and(38.29±6.63)U·L^(-1);GOT levels were(38.75±5.52)and(43.46±5.08)U·L^(-1);total bilirubin(TBIL)levels were(26.57±6.39)and(32.28±7.61)μmol·L^(-1);total cholesterol(TC)levels were(5.29±1.06)and(6.12±1.03)mmol·L^(-1);triglyceride(TG)levels were(1.45±0.43)and(1.69±0.46)mmol·L^(-1);high density lipoprotein(HDL)levels were(1.69±0.36)and(1.51±0.39)mmol·L^(-1);stone recurrence rates were 0(0 cases/45 cases)and 11.63%(5 cases/43 cases).The differences between groups were statistically significant(all P<0.05).The main adverse drug reactions in the treatment group were nausea and diarrhea,while there were no adverse drug reactions in the control group.The total incidence of adverse drug reactions in the treatment group and control group were 6.67%(3 cases/45 cases)and 0(0 cases/43 cases),with no statistically significant difference(P>0.05).Conclusion The application of ursodeoxycholic acid capsules after laparoscopic-assisted choledochoscopic lithotomy can promote the improvement of clinical symptoms and liver function in patients with intrahepatic and extrahepatic bile duct stones,accelerate lipid metabolism,and prevent stone recurrence.