【摘要】：目的:1、探討利膽湯對腹腔鏡下保膽取石術(shù)后膽囊功能及并發(fā)癥的治療效果;2、系統(tǒng)研究利膽湯對腹腔鏡下保膽取石術(shù)后膽囊功能及術(shù)后并發(fā)癥治療的藥理機(jī)理;3、為中醫(yī)藥在腹腔鏡下保膽取石術(shù)后的臨床應(yīng)用提供依據(jù);方法:選取2014年9月至2016年8月期間,在廣州市中醫(yī)醫(yī)院收治的擇期行腹腔鏡下保膽取石術(shù)且符合入組標(biāo)準(zhǔn)患者60例。按患者入組的先后,采用隨機(jī)數(shù)表法,分為空白組、對照組、治療組,各20例。三組在術(shù)后常規(guī)治療、護(hù)理、健康指導(dǎo)方面等相同,空白組不予溶石利膽類藥物;對照組術(shù)后第一天開始予華沙利膽片,每次2粒,每日3次,連續(xù)服用6個(gè)月;治療組術(shù)后第一天開始予利膽湯口服,早晚口服各一次,連續(xù)服用6個(gè)月。觀察三組患者保膽取石術(shù)后一般狀況,檢測三組患者術(shù)后6個(gè)月膽囊壁厚度、膽囊收縮率測定、膽囊結(jié)石復(fù)發(fā)情況和術(shù)后并發(fā)癥之間的差異。復(fù)查血、尿、糞常規(guī)、心、肝、腎功能檢查,作為藥物臨床安全性評估指標(biāo),并對治療前后數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,從而作出臨床療效及安全性評價(jià)。結(jié)果:1、在術(shù)后6個(gè)月膽囊壁厚度方面,三組術(shù)前與術(shù)后6個(gè)月膽囊壁厚度比較,均明顯降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。對照組與治療組均低于空白組,且治療組低于對照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。2、在術(shù)后6個(gè)月膽囊收縮率方面,對照組與治療組均高于空白組,且治療組高于對照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。3、術(shù)后6個(gè)月并發(fā)癥上,腹瀉發(fā)生率方面,治療組低于對照組和空白組低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);納差發(fā)生率方面,治療組低于空白組,差異有統(tǒng)計(jì)學(xué)意義,然而對照組與治療組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05);三組在腹脹、腹痛方面,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4、三組在結(jié)石復(fù)發(fā)率上,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。5、三組治療前后安全指標(biāo)比較無異常。結(jié)論:利膽湯對腹腔鏡下保膽取石術(shù)后膽囊功能具有明顯的良性調(diào)節(jié)作用,在改善膽囊收縮功能,降低膽囊厚度,減少術(shù)后腹瀉并發(fā)癥的發(fā)生,優(yōu)于華沙利膽片,改善納差方面與華沙利膽片效果相同。但對術(shù)后6個(gè)月內(nèi)腹脹、腹痛、結(jié)石復(fù)發(fā)率方面無明顯作用。利膽湯臨床應(yīng)用安全有效。
[Abstract]:Objective to investigate the therapeutic effect of Lidan decoction on gallbladder function and complications after laparoscopic cholelithiasis removal. To study systematically the pharmacological mechanism of Lidan decoction on gallbladder function and postoperative complications after laparoscopic cholelithiasis. The clinical application of traditional Chinese medicine (TCM) in laparoscopic cholecystectomy; Methods: from September 2014 to August 2016, 60 patients who were treated in Guangzhou traditional Chinese Medicine Hospital by laparoscopic cholelithiasis were selected. The patients were divided into three groups: blank group, control group and treatment group with 20 cases each. The three groups had the same routine treatment, nursing care and health guidance after operation, the blank group was not treated with litholytic and choledochic drugs, and the control group was given two tablets of Warsaw gallbladder three times a day for 6 months from the first day after operation. In the treatment group, Lidan decoction was given orally on the first day after operation and once in the morning and evening for 6 months. The general condition of the three groups after cholecystolithiasis was observed, and the difference of gallbladder wall thickness, gallbladder contraction rate, recurrence of gallstone and postoperative complications were detected 6 months after operation. Reexamination of blood, urine, fecal routine, heart, liver, kidney function, as a drug clinical safety evaluation index, and statistical analysis of data before and after treatment, so as to make clinical efficacy and safety evaluation. Results at 6 months after operation, the thickness of gallbladder wall in the three groups was significantly lower than that in the control group (P0.05). The control group and the treatment group were lower than the blank group, and the treatment group was lower than the control group, the difference was statistically significant (P0.05) .2.The gallbladder contraction rate of the control group and the treatment group were higher than that of the blank group at 6 months after operation, and the treatment group was higher than the control group. The incidence of diarrhea in treatment group was lower than that in control group and blank group, the difference was statistically significant (P0.05); the incidence of anorexia in treatment group was lower than that in blank group, and the incidence of anorexia in treatment group was lower than that in blank group. The difference was statistically significant, but there was no significant difference between the control group and the treatment group (P0.05); the three groups in abdominal distension, abdominal pain, the difference was not statistically significant (P0.05) .4, the three groups in the recurrence rate of stones, The difference was not statistically significant (P0.05). 5. There was no abnormal safety index before and after treatment in the three groups. Conclusion: Lidan decoction has obvious benign regulation effect on gallbladder function after laparoscopic cholecystectomy, which is superior to Warsaw gallbladder tablet in improving gallbladder contraction function, decreasing gallbladder thickness and reducing complications of postoperative diarrhea. The effect of improving anorexia was the same as that of Warsaw Lidan tablet. But there was no significant effect on abdominal distension, abdominal pain and recurrence rate of calculi within 6 months after operation. The clinical application of Lidan decoction is safe and effective.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.4
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本文編號：2196311