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医药导报, 2016, 35(11): 1201-1204
doi: 10.3870/j.issn.1004-0781.2016.11.011
大黄利胆胶囊预防微创保胆取石术后胆囊结石复发的疗效
Curative Effect of Rhubarb Choleretic Capsule on Prevention of Gallstone Recurrence after Minimal Invasive Gallstone Surgery
蒋欢欢1,, 张霞2, 闫玉洁3, 杜文泽4, 鲁蓓3,

摘要: 目的观察大黄利胆胶囊预防微创保胆取石术后胆囊结石复发的疗效。方法将60例行腹腔镜胆道镜微创保胆取石术(LRCL)的胆囊结石患者分治疗组和对照组各30例,治疗组术后给予大黄利胆胶囊,对照组不服用任何药物。术后定期对患者进行随访,并行B超检测,观察患者术后胆囊结石复发率、胆囊壁厚度和胆囊收缩率。结果与术前2 d相比,治疗组和对照组患者术后胆囊壁厚度均明显减小(治疗组,t=16.391,P<0.01;对照组,t=7.004,P<0.01),差异有统计学意义;胆囊收缩率明显增加(治疗组,t=-42.817,P<0.01;对照组,t=-23.066,P<0.01),差异有统计学意义。与对照组比较,治疗组患者胆囊壁厚度明显减小(t=-7.813,P<0.01)、胆囊收缩率明显增加(t=12.693,P<0.01),差异有统计学意义;治疗组患者结石复发例数明显少于对照组(χ2=4.32,P<0.05),差异有统计学意义。结论术后服用大黄利胆胶囊对预防LRCL术后胆囊结石复发具有积极作用。
关键词: 大黄利胆胶囊 ; 保胆取石术 ; 微创 ; 胆囊结石

Abstract:
ObjectiveTo observe the effect of rhubarb choleretic capsule on preventing gallstone recurrence after minimal invasive gallstone surgery. MethodsSixty patients with gallstone who received laparoscopic-choledochoscopy-assisted removal of cholecystolithotomy(LRCL) were divided into treatment group and control group.The treatment group was treated with rhubarb choleretic capsule after surgery,while the control group took no medicine.The patients were followed up and took B ultrasonic testing after surgery.The gallstonere currence rate,gallbladder wall thickness as well as gallbladder contraction efficiency were recorded. ResultsCompared with 2 days before operation,the gallbladder wall thickness were remarkably decreased in both groups (treatment group,t=16.391,P<0.01;control group,t=7.004,P<0.01),and the results were statistically significant.The gallbladder contraction ratios were markedly increased and there are statistically significant differences(treatment group,t=-42.817,P<0.01;control group,t=-23.066,P<0.01).Compared with the control group,the gallbladder wallthickness in rhubarb choleretic capsule treatment group decreased significantly (t=-7.813,P<0.01),while the gallbladder contraction ratio increased significantly(t=12.693,P<0.01) .The gallstone recurrence rate of the treatment group were obviously lower than the control group (χ2=4.32,P<0.05),the results were significant. ConclusionThere is a positive effect of taking rhubarb choleretic capsule after minimal invasive gallstone surgery to prevent the gallstone recurrence.
Key words: Rhubarb choleretic capsule ; Cholecystolithotomy with gallbladder reservation ; Microinvasive ; Cholecystolithiasis

由同一组医师治疗团队在全身麻醉下行规范LRCL,确保患者胆囊内无结石残留、胆囊管通畅,术中均合理应用抗菌药物预防感染,所有患者手术6 h后可适当起床活动,可进食水,当日可进流食;术后低脂饮食,1周后可恢复正常饮食。治疗组患者在术后胃肠功能恢复后给予大黄利胆胶囊(青海君吒药业有限公司,批准文号:国药准字Z20025609,规格:0.3 g),每次2粒,每日3次,饭后服用,疗程6个月。分别于术后3,6,12,18,24个月电话联系患者来我院普通外科门诊复诊,并由同一名专业医师为患者行胆囊超声检查。

近年来,随着生活水平的逐渐提高,饮食结构发生了很大改变,胆囊结石的发病率也逐年升高,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)是治疗胆囊结石的首选方法,但切除具有消化功能和免疫功能的胆囊后患者会出现腹胀、消化不良、腹泻、胃食管反流、结肠癌发病率增高、术中胆管损伤等并发症[1],极大影响了患者的生活质量。因此腹腔镜联合胆道镜保胆取石术(laparoscopic-choledochoscopy-assisted removal of cholecystolithotomy,LRCL)作为一种新的手术方式日益受到重视。然而保胆取石术后具有一定的结石复发率,因此预防保胆取石术后胆囊结石复发具有重要意义。大黄利胆胶囊具有清热利湿、解毒退黄的作用,是长期用于临床的中药制剂,对于胆汁淤积症、胆囊切除综合征的预防和治疗具有良好疗效[2-4],笔者通过临床对照研究,观察大黄利胆胶囊对微创保胆取石术后胆囊结石复发的影响。

1 资料与方法
1.1 临床资料

选取本院2013年1月—10月收治的60例行LRCL的胆石症患者,其中男19例,女41例,年龄31~75岁,平均(55.6±8.24)岁。病程1~48个月,平均(18.9±13.5)个月。纳入标准:①本地区常驻患者,年龄18~75岁,服药依从性好;②手术前B超提示胆囊形态、大小无异常,胆囊壁厚度≤4 mm;③伦德试餐试验(Lundh test-meal,LUNDH)试餐120 min后超声胆囊收缩功能试验提示胆囊收缩率≥30%[5];④术中探查胆囊未见萎缩,肝内外胆囊管无结石或有结石但可以挤入胆囊;⑤无胆管损伤、胰腺炎、胆系感染等并发症,未合并严重心血管系统、内分泌系统等基础疾病;⑥无上腹部手术史;⑦女性患者无怀孕、未哺乳;⑧自愿微创保胆取石并参加本临床研究,签署知情同意书。将60例患者按照病历号奇偶分成治疗组和对照组各30例。两组患者年龄、性别组成、结石数目、术前2 d胆囊壁厚度、术前2 d胆囊收缩率等一般情况具有可比性,差异无统计学意义(P>0.05)(表1)。

Tab.1 Comparison of baseline data between two groups 例,x¯±s,n=30
组别 性别 年龄/
病程/
个月
结石数目 胆囊壁厚/
mm
胆囊收缩率/
%
单发 多发
对照组 11 19 55.3±8.48 16.3±12.5 23 7 3.18±0.34 34.43±2.09
治疗组 8 22 55.8±8.00 21.5±14.0 21 9 3.21±0.33 34.19±1.93
t/χ2 0.693 1.599 1.522 0.341 0.351 0.459
P 0.405 0.110 0.134 0.559 0.727 0.648

Tab.1 Comparison of baseline data between two groups 例,x¯±s,n=30

1.2 治疗方法
1.3 观察指标

胆囊壁厚度:检查并记录患者术前2 d及术后胆囊壁厚度;②胆囊收缩率:检查并记录两组患者空腹胆囊最大长径、短径和纵高,依据患者体质量给予LUNDH试餐,餐后120 min检查并记录患者胆囊最大长径、短径和纵高,计算患者空腹及餐后胆囊容积(胆囊容积=0.52×长径×短径×纵高),计算两组患者胆囊收缩率。胆囊收缩率=(空腹容积-餐后容积)/空腹容积×100%;③结石复发:检查并记录患者术后结石复发例数。

1.4 统计学方法

数据结果用SPSS18.0版统计学软件进行分析,计量资料用均数±标准差( x ¯ ±s)表示,计量资料采用t检验,计数资料采用卡方检验,P<0.05表示差异有统计学意义。

2 结果
2.1 术后随访

60例患者均顺利完成随访,随访时间6~24个月,两组患者术后随访时间差异无统计学意义(P>0.05),见表2。

表2 两组各指标比较
Tab.2 Comparison of each index between two groups x¯±s,n=30
组别 随访时间/
个月
胆囊壁厚度/mm 结石复发
率/%
胆囊收缩率/%
术前2 d 末次随访 术前2 d 末次随访
对照组 21.8±4.85 3.18±0.34 2.59±0.31*1 26.67 34.43±2.09 49.83±3.00*1
治疗组 23.4±2.42 3.21±0.33 2.06±0.20*1 6.67 34.19±1.93 58.91±2.50*1
t/χ2 1.617 0.351 -7.813 -4.32 -0.459 12.693
P 0.113 0.727 0.000 0.038 0.648 0.000

Compared with the on preoperative d2,*1P<0.01

与本组术前2 d比较,*1P<0.01

表2 两组各指标比较

Tab.2 Comparison of each index between two groups x¯±s,n=30

2.2 安全性

治疗组服药期间共发生药品不良反应3例,其中1例患者出现恶心、纳差等胃部不适症状,经问诊后得知其服药方式为三餐前1 h,将服药方式改为饭后30 min后服用上述症状明显减轻;2例患者治疗期间出现丙氨酸氨基转移酶(ALT)轻度升高,分别为57和71 U·L-1,谷氨酸氨基转移酶(AST)水平在正常范围内。考虑患者ALT水平在2×ULN以下,未给予停药处理,密切监测血清ALT水平,两周后恢复正常水平。患者均完成了6个月药物治疗。

2.3 观察指标

2.3.1 组内比较 与术前2 d相比,两组患者术后胆囊壁厚度明显减小(治疗组,t=16.391,P<0.01;对照组,t=7.004,P<0.01),胆囊收缩率明显增加(治疗组,t=-42.817,P<0.01;对照组,t=-23.066,P<0.01)。

2.3.2 组间比较 与对照组比较,治疗组患者胆囊壁厚度明显减小,胆囊收缩率明显增加(P<0.01);治疗组患者结石复发例数明显低于对照组(P<0.05),结果见表2。

3 讨论

据统计,成人胆囊结石发病率约20%,其中>40岁肥胖女性为高危人群[6-7]。LC被认为是治疗胆囊结石的首选治疗方案,但胆囊切除后患者会出现胆汁反流性胃炎、胆囊切除术后综合征、胆总管结石复发、结肠癌发病率增高、胆道狭窄等并发症[8],严重影响患者术后生活质量。据文献报道,胆囊切除患者术后胆囊切除术后综合征发病率可达10%~30%,胆总管结石的发病率比胆囊未被切除的患者高1倍[9]。LRCL作为一种新的手术方式日益受到患者和医生们的青睐,但保胆取石术后会有较高的结石复发率[10],所以预防结石复发成为当前研究的重点。据文献报道,保胆取石术后1.5~2年为结石复发的高峰期[11],术后2年内需密切监测患者结石复发情况,因此本研究的随访时间选择术后24个月。

LRCL与传统的开腹保胆取石术相比具有出血少、创伤小、恢复快、住院时间短、术后感染概率小、并发症少、定位准确、操作简单快捷、取石彻底完全等优点[12]。但实施LRCL要求患者术前胆囊具有一定的收缩功能,未合并急性胆囊炎,且患者本人愿意行微创保胆取石术治疗[10]。所以本研究患者的入组标准为术前胆囊壁厚度≤4 mm、胆囊收缩率≥30%。入组患者经保胆取石治疗后,术后胆囊炎症明显减轻,胆囊收缩功能也有显著改善。提示LRCL可有效治疗胆囊结石,并且可以保留患者具有收缩功能的胆囊,对于预防胆囊切除术后并发症的发生具有积极作用。

胆囊结石依据其成分不同可分为胆固醇结石、胆色素结石和混合性结石,我国90%患者为胆固醇结石[13],本研究未将患者胆囊结石进行分类,需要在以后的研究中加以改进。胆固醇结石形成的原因主要与胆固醇过饱和、胆囊收缩动力不足、胆汁淤积以及胆汁酸浓度下降有关,胆色素结石形成主要与胆汁中胆汁酸、钙离子和游离胆红素含量有关[13],所以改善胆汁中胆固醇过饱和、增强胆囊收缩功能、增加胆汁酸浓度可预防结石复发。大黄利胆胶囊主要由大黄、余甘子和手掌参组成,具有解毒退黄、清热利湿、保护肝功能等功能。据文献报道[2-3],大黄利胆胶囊的主要成分大黄具有增加胆汁排泄、促进胆囊收缩、缓解胆汁淤积的作用,大黄中的主要成分大黄酸和大黄素可使奥狄括约肌松弛,有利于胆汁从胆囊排出、缓解胆汁淤积。在本研究中大黄利胆胶囊治疗组患者的胆囊收缩率明显高于对照组,提示用药后患者的胆囊收缩功能明显提高。除此之外,大黄素还具有抗炎、抗氧化功能[14],大黄利胆胶囊中的民族中药余甘子具有抗炎、抗渗出、降脂的作用[15],可显著减轻患者胆囊炎症反应。在本研究中,治疗组患者胆囊壁厚度明显低于对照组,提示术后服用大黄利胆胶囊可明显减轻保胆取石术后患者的胆囊炎症反应,对预防结石复发具有辅助作用。

The authors have declared that no competing interests exist.

参考文献

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To investigate the risk of intestinal cancer in a cohort of people who had undergone cholecystectomy for gallstones, and in a cohort of people who had been hospitalized for gallbladder disease but had not undergone cholecystectomy.Some investigators have suggested that cholecystectomy increases the risk of intestinal cancer. Despite extensive study, the evidence remains inconclusive. If there is doubt about safety, the question arises of whether patients considering the operation should be told of a possible risk. It is also increasingly clear that there are noncausal associations between gallstones and intestinal cancer.Analysis of record-linked hospital admission and mortality statistics for England from 1998 to 2008; calculation of ratio of rates of cancers in the cholecystectomy cohort and the gallbladder disease cohort compared with a control cohort.: In the first year after cholecystectomy, the rate ratios for cancer of the small intestine, colon, and rectum were significantly high at, respectively, 4.6 (95% confidence interval 3.9-5.5), 2.0 (1.9-2.1), and 1.7 (1.6-1.9). Rates of these cancers were also significantly high in people with gallstones without cholecystectomy. By 8 to 10 years after cholecystectomy, rate ratios had declined to nonsignificant levels.These cancers are associated with gallstones. The highest elevation of risk of cancer after cholecystectomy was at the shortest time interval after operation. Thereafter, the level of risk in the cholecystectomy and control cohorts gradually converged. The association in this study, between cholecystectomy and intestinal cancer, is very unlikely to be causal. Intestinal cancers are, on occasion, initially misdiagnosed as gallbladder disease.
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[2] 周一鸣,邢开,丛林,.大黄利胆胶囊联合熊去氧胆酸治疗肝内胆汁淤积症的疗效评价[J].北京医学,2015,37(3):279-280.
肝内胆汁淤积症(intrahaptic cholestasis, IC)是指各种原因引起的肝细胞内与胆汁分泌有关的细胞器结构与功能出现障碍,导致胆汁的生成或排泄障碍,胆汁淤积于肝内而引起胆汁流动阻滞,血液中以胆 汁成分增高为特征的症候群,而患者胆道无明显阻塞。 IC是许多肝病所共有的基础性病变。生化检查与胆汁淤积相关的肝酶升高,消退缓慢,临床治疗棘手。熊去氧胆酸是目前治疗IC的有效药物[1,2],但疗效 有时也不尽如人意。近年来发现中药在治疗IC方面有一定的疗效[3-5],我们对2012年8月至2014年7月在门诊就诊的急性IC患者,观察熊去氧胆 酸联合大黄利胆胶囊的疗效,报告如下。
DOI:10.15932/j.0253-9713.2015.3.024      URL    
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[3] 金鑫,史宪杰.大黄利胆胶囊治疗胆囊切除术后综合征患者的疗效观察[J].中国新药杂志,2012,21(21):2531-2534.
目的:观察大黄利胆胶囊治疗胆囊术后综合征的临床疗效。方法:144例诊断胆囊术后综合征患者分为观察组及对照组,观察组和对照组分别口服大黄利胆胶囊和消炎利胆片治疗6个月,观察临床疗效及前后VAS评分自身对照。结果:观察组患者主要症状腹痛、恶心较对照组均有明显缓解,总有效率分别为88.9%vs.75.0%(X2=12.517,P=0.000)、97.2%vs.88.9%(X2=4.923,P=0.043)。对照组纳差症状缓解优于观察组,但无统计学差异,86.1%vs.77.0%(X2=1.077,P=0.664)。观察组与对照组患者右上腹胀闷治疗前平均VAS分值无显著差异(7.02 vs.6.14,t=0.621,P=0.933),治疗后平均VAS分别为2.12和4.15,观察组疗效显著优于对照组(t=2.079,P=0.020)。结论:大黄利胆胶囊治疗胆囊术后综合征有确切疗效。
URL    
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[4] 蒋欢欢,张霞,杜汶泽,.围手术期应用大黄利胆胶囊对胆囊切除术后综合征的影响[J].现代中西医结合杂志,2016,25(1):71-73.
目的 探讨围手术期应用大黄利胆胶囊对预防胆囊切除术后综合征(PCS)的影响.方法 将200例因胆囊结石行腹腔镜胆囊切除术(LC)的患者随机分为治疗组和对照组,各100例;治疗组围手术期给予大黄利胆胶囊,对照组不服用任何药物,观察患者LC术后一般状况,比较2组术前1d和术后3d炎症因子水平的变化,并分别于LC术后2周、1个月、3个月对患者进行随访,评价PCS常见临床症状,统计发生率.结果 2组术后一般状况均较好,差异无统计学意义(P>0.05);治疗组患者术后3d血中炎症因子水平明显低于对照组(P<0.05);治疗组患者术后各时点PCS发生率均明显低于对照组(P均<0.05).结论 围手术期应用大黄利胆胶囊可明显改善患者LC术后炎症因子水平,对预防PCS的发生具有良好效果.
[本文引用:1]
[5] 孙太冉,张凯,石玉宝,.实时超声显像LUNDH试餐冰棒法在胆囊收缩功能检查中的应用价值[J/CD].中华医学超声杂志(电子版),2011,8(12):2558-2563. [本文引用:1]
[6] CONSTANTINESCU T,HUWOODAL JABOURI A K,BR-ÃTUCU E,et al.Gallstone disease in young population incidence,complicatios,therapeutic approach[J].Chirurgia,2012,107(5):579-582.
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[7] PREMKUMAR M,SABLE T.Obesity,dyslipidemia and cho-lesterol gallstone disease during one year of Antarctic residence[J].Rural Remote Health,2012,12(12):398.
Abstract INTRODUCTION: Age, gender, ethnicity, geographic location, diet, obesity, diabetes mellitus and dyslipidemia are known risk factors for development of gallstone disease (GD). We describe the development of four cases of symptomatic GD including a case of acute cholecystitis in Indian Antarctic expedition members during 1 year of polar residence and their response to 6 months of ursodeoxycholic acid (UDCA) therapy. METHODS: Twenty subjects were evaluated at baseline and at serial intervals using clinical history, dietary assessment, anthropometry, blood investigations and ultrasonography for development of gallstone disease. Ursodeoxycholic acid and lipid lowering agents were prescribed as indicated and response to therapy measured over a period of 1 year in Antarctica. RESULTS: Four cases of cholesterol GD and two cases of biliary sludge were detected after 4 months. Dyslipidemia including hypertriglyceridemia in four of 20 cases (20%), hypercholesterolemia in nine of 20 cases (45%) and low high density lipoprotein (HDL) cholesterol in six of 20 cases (30%) was seen to develop after 3 months of polar residence. Impaired glucose tolerance was found in three of 20 cases (15%), two of whom developed gallstones. Ursodeoxycholic acid therapy completely dissolved gallstones in three cases and led to partial resolution in one case at 6 months. A trial of lipid lowering agents and 1 month of UDCA led to resolution of biliary sludge in both cases. CONCLUSION: Obesity, dyslipidemia, impaired glucose tolerance and high fat and caloric intake were found to increase the risk of developing cholesterol GD during the Antarctic expedition. Ursodeoxycholic acid therapy was found to be efficacious in dissolution of gallstones and prevention of formation of larger stones in cases with gall bladder sludge. The effect of geographical factors such as exposure to colder environments on the development of GD needs further research.
DOI:10.5888/pcd9.120091      PMID:23157579      URL    
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[8] APREA G,CANFORA A,FERRONETTI A,et al.Morpho-functionnal gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease[J].BMC Surg,2012,12(1):1-5.
Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.
DOI:10.1186/1471-2482-12-S1-S5      PMID:23173777      URL    
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[9] 谭智明,张鹏,赵运平,.牛黄熊去氧胆酸结合微创保胆取石术在胆囊结石治疗的作用分析[J].肝胆外科杂志,2014,22(4):292-294.
目的观察牛磺熊去氧胆酸(TUDCA)降低微创保胆取石术后胆囊结石复发的临床效果。方法 42例胆囊结石患者被随机分为单纯保胆手术组21例和联合治疗组21例,联合治疗组在微创保胆取石术后口服TUDCA,每个月连续服用5 d后,停止口服25 d,为期1年。比较两组患者胆囊结石复发率、胆囊壁厚度及胆囊收缩功能的变化。结果在术后2年,单纯手术组患者胆囊结石症状复发率为33.3%(7/21),显著高于联合治疗组患者的4.8%(1/21)。单纯手术组5例(23.8%)胆囊结石复发,而加服药物组无复发(ⅹ2=5.6757,P0.05);单纯手术组患者术前和术后胆囊壁厚度分别为(3.95±0.56)mm和(3.74±0.68)mm,胆囊收缩功能分别为(38.24±4.33)%和(37.89±6.42)%,而加服药物组患者胆囊壁厚度分别为(2.88±0.67)mm和(2.43±0.71)mm,胆囊收缩功能分别为(48.78±6.45)%和(59.46±3.64)%,其改善程度均显著优于单纯手术组(P0.05)。结论微创保胆取石术后联用TUDCA口服能有效降低胆囊结石的复发,改善胆囊收缩功能。
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[10] 张宏,潘耀振,张浩,.微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的对比研究[J].中华临床医师杂志(电子版),2014,8(5):873-878.
目的探讨微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的疗效。方法统计贵阳医学院附属医院2011年5月至2012年5月收治的微创保胆取石治疗胆结石患者100例和腹腔镜胆囊切除治疗胆结石患者173例,保胆患者作为治疗组术后均口服牛磺熊去氧胆酸,胆囊切除患者作为对照组术后给予常规抗炎支持治疗,所有患者术后平均随访时间为1年,统计各组患者胆石症状改善情况和治疗组患者的胆囊壁厚、胆囊功能水平和结石复发率。结果治疗组患者手术前胆绞痛、腹胀、右上腹不适发生率分别为47.1%、21.8%、100%,胆囊壁厚为(3.42±0.49)mm,手术后1年胆绞痛、腹胀、右上腹不适发生率分别为2.3%、9.2%、2.3%,胆囊壁厚为(2.57±0.69)mm;胆囊结石患者组胆囊排空指数为43.11±20.82,保胆取石术后两年患者组胆囊排空指数为56.00±10.77,正常组胆囊排空指数为56.65±13.45,患者手术前后胆石症状、胆囊壁厚的差异均具有统计学意义(P0.05),保胆取石术后两年患者组胆囊排空指数与正常组差异无统计学意义(P0.05),而与胆囊结石组患者组差异有统计学意义(P0.05);术后1年治疗组患者腹泻、腹胀、右上腹不适症状发生率分别为2.3%、9.2%、2.3%,对照组患者腹泻、腹胀、右上腹不适症状发生率分别为33.6%、25.5%、17.3%,两组之间胆石症状的差异均具有统计学意义(P0.05),治疗组患者术后胆固醇结石复发率有降低趋势。结论保胆取石术后口服牛磺熊去氧胆酸对术后患者胆囊功能的恢复及预防胆囊胆固醇结石的复发有重要意义。
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[11] 陈建飞,赵期康,李晋忠,.牛黄熊去氧胆酸与熊去氧胆酸对预防保胆术后结石复发的临床研究[J].中国微创外科杂志,2014,14(4):311-313.
目的:评价牛磺熊去氧胆酸( TUDCA)与熊去氧胆酸( UDCA)对保胆取石术后患者预防胆囊结石复发的差异性及其临床价值。方法2010年10月~2011年12月,我院内镜微创保胆手术成功的313例胆囊结石按病历号奇偶分为TUDCA组(n=161)和UDCA组(n=152),术后2周TUDCA组口服牛磺熊去氧胆酸胶囊(商品名:滔罗特,意大利贝斯迪大药厂生产,进口批文号:H20070200、H20110233)500 mg,每晚1次,连续服用5天后,停药10天,15天为一周期;UDCA组口服熊去氧胆酸胶囊(商品名:优思弗,德国Dr.Falk药厂生产,进口批文号H20050181)500 mg,每晚1次。两组服药疗程均为180天。两组术后护理、饮食等均相同。术后定期随访及复查B超,观察记录胆囊结石复发、胆囊壁厚度变化以及胆囊收缩率。结果2组随访时间12~30个月,TUDCA组和UDCA组2年胆囊结石复发率分别为3.7%和12.4%(log-rank χ2=5.304,P=0.021)。结论内镜微创保胆取石术后口服TUDCA预防胆囊结石的复发效果优于UDCA。
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[12] WEI S.The clinical application of the hard gallbladder end oscope combined with soft choledochoscope in the surgery of laparoscopic microscopic trauma for the removal of calculi and preservation of gallbladder[J].J Laparoendosc Adv Surg Tech A,2013,23(2):106-108.
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[13] 王坤,葛春林.胆汁成分改变及其相关疾病研究进展[J].中国医学工程,2012,20(7):197-188.
胆汁是胆道内的消化液,其发挥功能的主要成分是胆汁酸,胆汁成分在正常情况下保持相对稳定,当稳定性被破坏时,就会引起相关疾病。本文综述胆汁成分改变与胆石症、胆管损伤、胆系感染、乙型肝炎及癌症的关系,为深入探讨胆汁成分改变对相关疾病机制及治疗措施研究的意义提供理论基础。
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[14] 刘静,王丽.大黄素的研究进展[J].中国药房,2014,25(35):3351-3354.
目的:了解大黄素的研究近况,为其开发、应用提供参考。方法:检索、分析和归纳国内外近年来有关大黄素的文献,对其提取、分离、含量测定及药理作用进行综述。结果与结论:大黄素的提取方法为有渗漉提取法、微波提取法、超声提取法和酸碱提取法等;大黄素的分离有高速逆流色谱法、硅胶色谱法、聚酰胺色谱法、pH梯度分离法;大黄素的药理作用集中在抗微生物、抗肿瘤、肾保护、肝保护、胃肠道保护等方面。
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[15] 何晓敏. 余甘子药理作用研究进展[J].中国中医药科技,2014,21(5):593-595.
余甘子为大戟科植物余甘子(Phyllanthus emblica L.)的干燥成熟果实[1],是藏族、维吾尔族、傣族、壮族、白族、苗族、布依族等民族的习用药材[2]。在我国,余甘子作为民族用药有着2000多年的历史,云南、广西和福建当地将余甘子作为一种食品来使用,当地居民发现长期食用余甘子可有效治疗胆道疾病[3]。诸多古代本草文献也记载着余甘子的各种功效,如《新修本草》记载:余甘子主风虚热气。《本草纲目拾遗》记载:余甘子主补益,强气力。
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大黄利胆胶囊
保胆取石术
微创
胆囊结石

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Microinvasive
Cholecystolithiasis

作者
蒋欢欢
张霞
闫玉洁
杜文泽
鲁蓓

JIANG Huanhuan
ZHANG Xia
YAN Yujie
DU Wenze
LU Bei