本文選題：十二味疏肝利膽沖劑 + 肝外膽管結(jié)石�。� 參考：《安徽中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的:觀察腹腔鏡膽總管探查聯(lián)合十二味疏肝利膽沖劑治療肝外膽管結(jié)石的臨床療效。方法:將安徽中醫(yī)藥大學(xué)第一附屬醫(yī)院普外1科2012年1月-2014年12月收治住院并手術(shù)的肝外膽管結(jié)石患者47例,隨機分為2組。對照組24例,行腹腔鏡膽總管探查術(shù)、術(shù)中膽道鏡、T管引流術(shù),術(shù)后給予常規(guī)補液、抗感染治療;研究組23例,在對照組療法的基礎(chǔ)上給予十二味疏肝利膽沖劑口服,每次1袋,1日3次,療程為2周。治療結(jié)束后分別觀察2組手術(shù)前及術(shù)后7天的中醫(yī)證候、血常規(guī)、肝功能、血清膽汁生化等指標(biāo),術(shù)后第1d、3d、5d、7dT管引流量,術(shù)后腹腔引流時間、術(shù)后補液量及住院時間、住院總費用,隨訪遠期并發(fā)癥等之間的差異。采用SPSS 17.0統(tǒng)計軟件進行數(shù)據(jù)統(tǒng)計處理,計量資料采用t檢驗,用—x±s表示;計數(shù)資料采用x2檢驗;P0.05認為差異有統(tǒng)計學(xué)意義。結(jié)果:兩組手術(shù)前中醫(yī)證候、血常規(guī)、肝功能、血清膽汁生化差異無顯著性(P0.05);同組術(shù)后7天中醫(yī)證候評分與手術(shù)前比較,差異有顯著性(P0.01),術(shù)后7天,兩組間中醫(yī)證候評分比較,差異有顯著性(P0.01);同組術(shù)后7天WBC、N%與手術(shù)前比較,差異有顯著性(P0.05或P0.01),術(shù)后7天,兩組WBC計數(shù)、N%比較,差異有顯著性(P0.01);同組術(shù)后7天ALT、AST、AKP、GGT、TBA、TBIL、CB、UCB與手術(shù)前比較,差異有顯著性(P0.01),術(shù)后7天,兩組ALT、AST、AKP、GGT、TBA、TBIL、CB、UCB比較,差異有顯著性(P0.01);兩組術(shù)后第1天、第3天T管膽汁引流量變化比較,差異無顯著性(P0.05),術(shù)后第5天、第7天T管膽汁引流量變化比較,差異有顯著性(P0.05或P0.01);兩組腹腔引流時間、術(shù)后補液量、住院時間及總費用比較,差異有顯著性(P0.05或P0.01)。結(jié)論:腹腔鏡膽總管探查聯(lián)合十二味疏肝利膽沖劑治療肝外膽管結(jié)石臨床療效的研究表明:(1)十二味疏肝利膽沖劑能改善腹腔鏡膽總管探查T管引流術(shù)后患者肝膽濕熱證候;(2)腹腔鏡膽總管探查術(shù)后應(yīng)用十二味疏肝利膽沖劑具有控制膽道感染、減輕膽道炎癥作用;(3)腹腔鏡膽總管探查術(shù)后應(yīng)用十二味疏肝利膽沖劑具有恢復(fù)肝功能、調(diào)節(jié)肝臟代謝作用;(4)腹腔鏡膽總管探查術(shù)后應(yīng)用十二味疏肝利膽沖劑具有促進膽汁的分泌與排泄、減輕膽汁淤積作用;(5)腹腔鏡膽總管探查術(shù)后應(yīng)用十二味疏肝利膽沖劑可以縮短患者住院時間,減少治療費用;(6)腹腔鏡膽總管探查術(shù)后應(yīng)用十二味疏肝利膽沖劑可能具有防治術(shù)后結(jié)石復(fù)發(fā)的作用。中醫(yī)中藥對于膽石癥的預(yù)防、治療及康復(fù)等方面不僅具有重要的臨床意義,而且也帶來了良好的社會效應(yīng),中西醫(yī)結(jié)合治療膽石疾病有著誘人的前景,值得今后進一步深入系統(tǒng)研究。
[Abstract]:Objective: to observe the clinical effect of laparoscopic choledochus exploration combined with 12 kinds of Shugan Lidan granule in the treatment of extrahepatic cholelithiasis.Methods: from January 2012 to December 2014, 47 patients with extrahepatic cholelithiasis were randomly divided into 2 groups.In the control group, 24 cases were treated with laparoscopic choledochus exploration, intraoperative choledochoscope T-tube drainage, routine fluid resuscitation and anti-infection treatment after operation, and 23 cases in the study group were given oral administration of 12 kinds of Shugan Lidan granule on the basis of the control group.Each time 1 bag, 3 times a day, the course of treatment is 2 weeks.After treatment, the TCM syndrome, blood routine, liver function, serum bile biochemistry and other indexes were observed before and 7 days after operation respectively, and the drainage volume, the volume of fluid rehydration and the hospitalization time of the two groups were observed at the 1st day, 3 days after operation, 5 days after operation, 7 days after operation, and 7 days after operation, respectively.Differences in total hospital costs and long-term complications during follow-up.The statistical data were processed by SPSS 17.0 statistical software, the measurement data were expressed by t-test and -x 鹵s, and the counting data were expressed by using x2 test (P0.05), the difference was statistically significant.Results: there was no significant difference in TCM syndrome, blood routine, liver function and serum bile biochemistry between the two groups before operation, and there was significant difference in TCM syndrome score between the same group on the 7th day after operation and before operation, and on the 7th day after operation, there was a significant difference between the two groups in TCM syndrome score.On the 7th day after operation, there was a significant difference in the WBC count between the two groups (P 0.05 or P 0.01), and on the 7th day after operation, there was a significant difference between the two groups in the WBC count (P 0.01), and in the same group on the 7th day after operation, there was a significant difference between the same group and the pre-operation group (P 0.01), and on the 7th day after operation, there was a significant difference between the same group and the pre-operation group (P 0.01), and on the 7th day after operation, there was a significant difference in the WBC count between the two groups (P < 0.05), the difference between the two groups was significant (P < 0.05), and the difference between the two groups was significant (P < 0.05).The difference between the two groups was significant (P 0.01), but there was no significant difference between the two groups on the first day, the third day after operation, the difference was not significant (P 0.05), but on the 5th day and the 7th day after operation, there was no significant difference between the two groups in the volume of bile drainage from T tube, and there was no significant difference between the two groups in the volume of bile drainage from T tube on the 5th and 7th day after operation.There was significant difference between the two groups (P 0.05 or P 0.01), the time of abdominal drainage, the amount of fluid rehydration, the time of hospitalization and the total cost, there was significant difference between the two groups (P 0.05 or P 0.01).Conclusion: the clinical effect of laparoscopic choledochus exploration combined with 12 kinds of Shugan Lidan granule in the treatment of extrahepatic cholelithiasis shows that 12 kinds of Shugan Lidan granule can improve the liver and bile duct after laparoscopic choledochus exploration and T tube drainage in patients with extrahepatic choledocholithiasis.After laparoscopic choledochus exploration, twelve kinds of Shugan Lidan granule were used to control biliary tract infection.After laparoscopic choledochus exploration, twelve kinds of Shugan Lidan granule were used to restore liver function.Regulating the function of liver Metabolism after Laparoscopic choledochus exploration, the application of 12 kinds of Shugan Lidan granule can promote the secretion and excretion of bile.After laparoscopic choledochus exploration, the application of 12 kinds of Shugan Lidan granule can shorten the hospitalization time of the patients.The application of 12 kinds of Shugan Lidan granule after laparoscopic choledochus exploration may have the effect of preventing and treating the recurrence of stones after laparoscopic choledochus exploration.Chinese medicine not only has important clinical significance for the prevention, treatment and rehabilitation of cholelithiasis, but also brings good social effect.It is worth further systematic study in the future.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.4

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本文編號：1766423