| 摘要: |
| 目的:探讨大黄灵仙方对乙肝肝硬化合并肝内外胆管结石患者行腹腔镜胆总管切开取石术后的临床效果。方法:选取2023年1月—12月广西中医药大学第一附属医院肝胆外科收治的120例因肝内外胆管结石并乙肝肝硬化行腹腔镜胆总管切开探查取石术(LCBDE)治疗的患者，依据随机数字表法随机平均分为三组，空白组术后予常规抗感染等治疗，对照组加用熊去氧胆酸片，观察组加用大黄灵仙方，连续服药至术后3个月，比较三组患者的临床疗效。结果:空白组、对照组、观察组的治疗有效率分别为80%、85%、95%，其中观察组有效率高于空白组(P ＜0.05)，余差异无统计学意义(P ＞0.05)；治疗后，观察组患者的白细胞(WBC)、中性粒细胞(NE)、C反应蛋白(CRP)、谷丙转氨酶(ALT)、谷草转氨酶(AST)均低于空白组及对照组(P ＜0.05)，观察组与对照组的总胆汁酸(TBA)与直接胆红素(DBIL)水平相近，均低于空白组，差异有统计学意义(P ＜0.05)；观察组术后心理焦虑发生率低于空白组，差异有统计学意义(P ＜0.05)；Child-Pugh评分高及CRP水平高是乙肝肝硬化合并肝内外胆管结石患者LCBDE术后结石复发的危险因素。结论:乙肝肝硬化合并肝内外胆管结石患者LCBDE术后应用大黄灵仙方具有较好的临床疗效，能增强手术疗效，减轻炎症反应，促进肝脏功能及胃肠功能恢复，减少术后结石复发，还能减少术后焦虑发病率，实现快速康复。 |
| 关键词: 大黄灵仙方 肝内外胆管结石 乙肝肝硬化 腹腔镜胆总管探查取石术 |
| DOI：10.3969/j.issn.1007-6948.2025.05.008 |
| 投稿时间：2025-01-17 |
| 基金项目:国家自然科学基金项目(82360889)；广西重点研发计划项目(2021AB11020) |
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| Clinical effect of Dahuang Lingxian decoction on patients with hepatitis B cirrhosis complicated with intrahepatic and extrahepatic bile duct stones after laparoscopic choledocholithotomy |
| TENG Jin-hao,YU Yuan,CHEN Wei-tang |
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| Abstract: |
| Objective To explore the clinical effect of Dahuang Lingxian decoction on patients with hepatitis B cirrhosis complicated with intrahepatic and extrahepatic bile duct stones after laparoscopic choledocholithotomy. Methods From January 2023 to December 2023, 120 patients with intrahepatic and extrahepatic bile duct stones and hepatitis B cirrhosis who were treated with LCBDE were selected from the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine. According to the random number table method, they were randomly divided into 3 groups. The blank group was treated with conventional anti-infection after operation. The control group was treated with ursodeoxycholic acid, and the observation group was treated with Dahuang Lingxian decoction. The clinical efficacy of the three groups was compared. Results The effective rates of the blank group, the control group and the observation group were 80%, 85% and 95%, respectively, and the effective rate of the observation group was higher than that of the blank group (P <0.05). After treatment, the levels of WBC, NE, CRP, ALT and AST in the observation group were lower than those in the blank group and the control group (P <0.05). The levels of TBA and DBIL in the observation group and the control group were similar, which were lower than those in the blank group (P <0.05). The incidence of postoperative psychological anxiety in the observation group was lower than that in the blank group, the difference was statistically significant (P <0.05). High level of Child-Pugh score and CRP were the risk factors for stone recurrence after LCBDE. Conclusion The application of Dahuang Lingxian decoction after LCBDE in patients with intrahepatic and extrahepatic bile duct stones complicated with hepatitis B cirrhosis has a good clinical effect. It can not only enhance the surgical effect, reduce the inflammatory response, promote the recovery of liver function and gastrointestinal function, reduce the recurrence of postoperative stones, but also reduce the incidence of postoperative anxiety, and achieve rapid recovery. |
| Key words: Dahuang Lingxian decoction intrahepatic and extrahepatic bile duct stones hepatitis B cirrhosis laparoscopic common bile duct exploration |
