自拟扶胆汤对腹腔镜胆囊切除术后胆型Oddi括约肌功能障碍的防治效果观察
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摘要
目的:观察自拟扶胆汤对腹腔镜胆囊切除术后胆型Oddi括约肌功能障碍(SOD)的防治效果。方法:选取我院2014年1月至2016年1月期间收治的因腹腔镜胆囊切除术后出现胆型SOD入院的患者88例,随机分为观察组和对照组,每组44例。两组均给予抗感染、纠正水电解质紊乱等常规治疗,观察组在此基础上给予我院自拟扶胆汤治疗。评估两组治疗前后腹痛、腹胀改善情况,比较两组治疗后胆道系统压力与胆总管直径,并观察两组临床治疗疗效。结果:治疗前两组腹痛、腹胀改善评分比较无明显差异(P>0.05),治疗后腹痛、腹胀改善评分均明显降低(P<0.05),且观察组腹痛改善评分(2.77±1.30)分、腹胀改善评分(1.62±0.52)分均明显低于对照组(P<0.05)。与对照组相比,观察组Oddi括约肌基础压(15.01±5.57)mm Hg、蠕动波幅(117.71±24.60)mm Hg、胆总管压力(9.95±5.24)mm Hg均显著较低(P<0.05),胆总管直径(9.60±2.81)mm显著较短(P<0.05)。观察组总有效率为93.18%显著高于对照组77.27%(P<0.05)。结论:自拟扶胆汤对腹腔镜胆囊切除术后胆型SOD防治效果显著,可明显改善患者腹痛、腹胀等症状,对降低胆道系统压力水平与胆总管直径也有显著地作用。
Objective: To investigate the effect of Self-designed Fudan Decoction in preventing and treating biliary sphincter of Oddi dysfunction( SOD) after laparoscopic cholecystectomy. Methods: Eighty-eight patients with biliary SOD after laparoscopic cholecystectomy who were admitted in our hospital from January 2014 to January 2016 were randomly divided into observation group and controlled group,44 cases in each group. Both groups were given conventional treatment for anti-infection andcorrecting water and electrolyte disorders. On the basis,the observation was treated with Self-designed Fudan Decoction. The relief of abdominal pain and abdominal distension in the two groups was evaluated before and after treatment. The biliary system pressure and bile duct diameter were compared between the two groups after treatment,and the therapeutic effect in both groups were observed. Results: There were no significant differences in the scores of abdominal pain and abdominal distension between the two groups( P > 0. 05). After treatment,the scores of relief of abdominal pain and abdominal distension were significantly lower( P < 0. 05). The scores of relief of abdominal pain( 2. 77 ± 1. 30) and abdominal distension( 1. 62 ± 0. 52) in the observation group were significantly lower than those in the controlled group( P < 0. 05). Compared with the controlled group,Oddi sphincter basal pressure [( 15. 01 ± 5. 57) mmH g],peristalsis amplitude [( 117. 71 ± 24. 60) mmH g] and total bile duct pressure[( 9. 95 ±5. 24) mmH g]of the observation group were significantly lower( P <0. 05),and diameter of the common bile duct [( 9. 60± 2. 81) mm]was significantly shorter( P < 0. 05). The total response rate in the observation group( 93. 18%) was significantly higher than that in the controlled group( 77. 27%)( P < 0. 05). Conclusion: The effect of Self-designed Fudan Decoction in preventing and treating biliary SOD after laparoscopic cholecystectomy is significant. It can significantly relieve abdominal pain,abdominal distension and other symptoms,and can significantly reduce the biliary system pressure and common bile duct diameter.
Objective: To investigate the effect of Self-designed Fudan Decoction in preventing and treating biliary sphincter of Oddi dysfunction( SOD) after laparoscopic cholecystectomy. Methods: Eighty-eight patients with biliary SOD after laparoscopic cholecystectomy who were admitted in our hospital from January 2014 to January 2016 were randomly divided into observation group and controlled group,44 cases in each group. Both groups were given conventional treatment for anti-infection andcorrecting water and electrolyte disorders. On the basis,the observation was treated with Self-designed Fudan Decoction. The relief of abdominal pain and abdominal distension in the two groups was evaluated before and after treatment. The biliary system pressure and bile duct diameter were compared between the two groups after treatment,and the therapeutic effect in both groups were observed. Results: There were no significant differences in the scores of abdominal pain and abdominal distension between the two groups( P > 0. 05). After treatment,the scores of relief of abdominal pain and abdominal distension were significantly lower( P < 0. 05). The scores of relief of abdominal pain( 2. 77 ± 1. 30) and abdominal distension( 1. 62 ± 0. 52) in the observation group were significantly lower than those in the controlled group( P < 0. 05). Compared with the controlled group,Oddi sphincter basal pressure [( 15. 01 ± 5. 57) mmH g],peristalsis amplitude [( 117. 71 ± 24. 60) mmH g] and total bile duct pressure[( 9. 95 ±5. 24) mmH g]of the observation group were significantly lower( P <0. 05),and diameter of the common bile duct [( 9. 60± 2. 81) mm]was significantly shorter( P < 0. 05). The total response rate in the observation group( 93. 18%) was significantly higher than that in the controlled group( 77. 27%)( P < 0. 05). Conclusion: The effect of Self-designed Fudan Decoction in preventing and treating biliary SOD after laparoscopic cholecystectomy is significant. It can significantly relieve abdominal pain,abdominal distension and other symptoms,and can significantly reduce the biliary system pressure and common bile duct diameter.
引文
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[11]庞雪莹,刘松江.扶胆汤对Oddi括约肌功能紊乱患者生活质量的干预[J].生物技术世界,2015,1(1):134
[2]邓金芳,饶明.中西医结合治疗胆囊切除术后胆管Ⅱ型Oddi括约肌功能障碍的临床观察[J].胃肠病学和肝病学杂志,2013,22(6):588~590
[3]罗马委员会.功能性胃肠病的罗马诊断标准[J].现代消化及介入诊疗,2007,12(2):137~140
[4]Geenen JE,Hogan WJ,Dodds WJ,et al.The in patients with sphincter-of-Oddi dysfunction[J].N Engl J Med,1989,320(2):82~87
[5]翁坚军,关亚萍,朱峰,等.胆囊切除术后患者胆道Ⅲ型Oddi括约肌功能障碍的治疗[J].中华肝胆外科杂志,2016,22(1):37~39
[6]郑筱英.中药新药临床研究指导原则[M].北京:中国医药科技出版社2002:143
[7]刘万里,颜延凤,许立.通降合剂对犬胆囊切除后胆道Oddi括约肌功能的影响及其机制研究[J].江苏中医药,2015,47(1):74~77
[8]陈静.消炎利胆汤加减结合腹腔镜手术治疗胆囊炎伴胆石症临床观察[J].四川中医,2015,33(11):111~113
[9]刘磊,王建华,张习禄,等.金茵大柴胡汤联合西药治疗单纯胆囊切除术后Oddi括约肌功能紊乱35例[J].河南中医,2014,34(2):272~274
[10]宋睿,王长淼,薛文博,等.芍药甘草汤含药血清的制备及对高胆固醇血症兔Oddi括约肌细胞内Ca~(2+)浓度的影响[J].中华中医药学刊,2014,32(11):2612~2615
[11]庞雪莹,刘松江.扶胆汤对Oddi括约肌功能紊乱患者生活质量的干预[J].生物技术世界,2015,1(1):134