摘要
目的：研究化石利胆中药对逆行胰胆管造影术（ERCP）取石后的胆石症患者胆汁成石趋势的影响。方法将144例行ERCP、EST、网篮取石术、ENBD术的胆石症患者随机分成化石利胆中药组、熊去氧胆酸（UDCA）组及对照组，测定术后第1天、第7天、第14天胆汁总胆红素(TB)、直接胆红素(DB)、胆固醇(CH)、磷脂(PHL)和总胆盐(TBS)含量，并计算出致石指数(L.I.)、间接胆红素百分比(UCB%)和胆汁成石趋势综合值(z值)，同时进行随访，随访时间3～12个月，平均6个月；患者每3个月或出现腹痛症状时复查腹部B超、CT、MRCP检查。结果术后第1天，3组间的L.I.、UCB%、Z值的差异均无统计学意义(P＞0.05)，且Z值＞临界值(44.7)。UDCA组和对照组术后第7天与第14天的L.I.、UCB%、Z值的差异均无统计学意义(P＞0.05)，与术后第1天相比，化石利胆中药组第7天UCB%降低(P＜0.05)；术后第14天，化石利胆中药组的L.I.UCB％、和z值均明显下降(P＜0.05)，z值＜临界值；随访1年后，UDCA组和对照组胆石的复发率无统计学意义(P＞0.05)，化石利胆中药组胆石的复发率明显下降（P＜0.05）。结论化石利胆中药能调节胆汁成分，从而化石、抑制胆石形成，降低胆石的复发。
Abstract
Objective To study the influence of Huashilidan Decoction on the lithogenic tendency in Choledocholithiasis After ERCP. Methods 144 patients with ERCP, EST, ENBD, basket lithotomy surgery cholelithiasis patients were randomly divided into fossil cholagogue herbs group, ursodeoxycholic acid (UDCA) group and control group were determined after first days, seventh days, fourteenth days, bilirubin (TB), direct bilirubin (DB), cholesterol (CH), phospholipid (PHL) and total bile salt (TBS) content, and calculate the lithogenic index (L.I.), indirect bilirubin (UCB%) and the percentage of the lithogenic tendency of comprehensive value (Z value), and were folowed up.the folow-up time ranged from 3 to 12 months, average 6 months;patients every 3 months or abdominal pain symptoms were abdominal B ultrasound, CT, MRCP examination. Results First days after operation, between the 3 groups in L.I., UCB%, Z values were not statisticaly significant (P > 0.05), and the Z value, the critical value (44.7). UDCA group and the control group after seventh days and fourteenth days of L.I., UCB%, Z values were not statisticaly significant (P>0.05), compared with first days after operation, the fossil cholagogue herbs seventh days in group UCB% decreased (P<0.05);fourteenth days after operation, the fossil cholagogue herbs group, L.I.UCB% and Z value were significantly decreased (P<0.05), Z<critical value; after 1 years folow-up, the UDCA group and the control group of galstone recurrence rate had no statistical significance (P>0.05), Chinese medicine group fossil galbladder galstone recurrence rate decreased significantly (P<0.05). Conclusion Huashilidan Decoction can modulate the bile components,and thus may reduce the tendency of galstone formation, reduce the risk of galstone recurrence.
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