大柴胡汤联合四金汤治疗肝胆湿热型胆总管结石的临床观察(1)
摘要：目的 观察大柴胡汤联合四金汤治疗肝胆湿热型胆总管结石临床疗效。方法 选择来自徐州市中医药消化内科住院胆总管结石患者60例，随机分为治疗组和对照组，各30例。对照组给予常规治疗，治疗组在对照组的基础上加服中药大柴胡汤合四金汤，于第6天行CT、磁共振或彩超超检查，统计胆总管结石排出率，观察患者临床症状、体征好转或消失情况。结果 治疗组胆总管结石排出率为46.67%，皮肤巩膜黄染28例均好转，23例发热消失，胆源性胰腺炎均消失;对照组胆总管结石排出率为13.33%，皮肤巩膜黄染改善13例，发热消失者9例，胰腺炎好转者2例，组间比较，差异具有统计学意义(P<0.05)。结论 大柴胡汤联合四金汤治疗肝胆湿热型胆总管结石，具有促进结石排出，促进胆汁排泄，改善临床症状的效果。
关键词：胆总管结石;中药排石;大柴胡汤;四金汤
中图分类号：R259 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.07.052
, 百拇医药
文章编号：1006-1959(2019)07-0166-02
Abstract：Objective To observe the clinical efficacy of Dachaihu Decoction combined with Sijin Decoction in the treatment of hepatic gallbladder damp-heat choledocholithiasis. Methods 60 patients from the Department of Gastroenterology，Xuzhou Traditional Chinese Medicine， were randomly divided into the treatment group and the control group， 30 cases each. The control group received routine treatment. The treatment group was given the Chinese medicine Dachaihu Decoction and Sijin Decoction on the basis of the control group. On the 6th day， CT， MRI or color Doppler ultrasonography was performed to count the discharge rate of common bile duct stones， and the clinical symptoms and signs were improved. Or disappeared. Results In the treatment group， the discharge rate of common bile duct stones was 46.67%， 28 cases of skin sclera yellow staining were improved， 23 cases of fever disappeared， and biliary pancreatitis disappeared. The control group of common bile duct stones was 13.33%， and the skin sclera yellow staining improved. In 13 cases， 9 cases of fever disappeared and 2 cases of pancreatitis improved，the difference between the groups was statistically significant (P<0.05). Conclusion Dachaihu Decoction combined with Sijin Decoction for the treatment of hepatobiliary damp-heat choledocholithiasis has the effect of promoting stone discharge， promoting bile excretion and improving clinical symptoms.
, 百拇医药
Key words：Choledocholithiasis;Chinese medicine row stone;Dachaihu soup;Sijin Decoction
膽总管结石(choledocholithiasis)多位于胆总管的中下段，症状有轻有重，轻症患者可无症状，重症患者可形成化脓性胆管炎，胆源性胰腺炎，感染性休克，多脏器功能衰竭，甚至死亡等。临床比较常见的是以黄疸、腹痛还有发热等前来就诊[1]。西医治疗胆总管结石主要是通过经内镜逆行胰胆管造影术及胆总管结石取出术，但有出血、穿孔、胆道感染、急性胰腺炎等并发症。近年来中药治疗胆总管结石成为了热门，结合临床经验及文献报道，中药治疗胆石症方面有以下作用[2-4]：①增加肝脏胆汁分泌量;②促进胆囊收缩;③促进胆汁分泌及排泄，松弛Oddis括约肌;④调节胆汁中结合胆红素、非结合胆红素的比例，减少非结合胆红素;⑤调节胆汁中的胆固醇、胆酸、胆盐含量，增加亲水性胆酸含量;⑥抗感染、减轻炎症反应。故对于胆总管结石≤10 mm者，我院多采用中医中药治疗，临床治疗多予大柴胡汤合四金汤加减化裁，疗效颇著，现报道如下。, http://www.100md.com(铉力 王晓红 胡兵)
关键词：胆总管结石;中药排石;大柴胡汤;四金汤
中图分类号：R259 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.07.052
, 百拇医药
文章编号：1006-1959(2019)07-0166-02
Abstract：Objective To observe the clinical efficacy of Dachaihu Decoction combined with Sijin Decoction in the treatment of hepatic gallbladder damp-heat choledocholithiasis. Methods 60 patients from the Department of Gastroenterology，Xuzhou Traditional Chinese Medicine， were randomly divided into the treatment group and the control group， 30 cases each. The control group received routine treatment. The treatment group was given the Chinese medicine Dachaihu Decoction and Sijin Decoction on the basis of the control group. On the 6th day， CT， MRI or color Doppler ultrasonography was performed to count the discharge rate of common bile duct stones， and the clinical symptoms and signs were improved. Or disappeared. Results In the treatment group， the discharge rate of common bile duct stones was 46.67%， 28 cases of skin sclera yellow staining were improved， 23 cases of fever disappeared， and biliary pancreatitis disappeared. The control group of common bile duct stones was 13.33%， and the skin sclera yellow staining improved. In 13 cases， 9 cases of fever disappeared and 2 cases of pancreatitis improved，the difference between the groups was statistically significant (P<0.05). Conclusion Dachaihu Decoction combined with Sijin Decoction for the treatment of hepatobiliary damp-heat choledocholithiasis has the effect of promoting stone discharge， promoting bile excretion and improving clinical symptoms.
, 百拇医药
Key words：Choledocholithiasis;Chinese medicine row stone;Dachaihu soup;Sijin Decoction
膽总管结石(choledocholithiasis)多位于胆总管的中下段，症状有轻有重，轻症患者可无症状，重症患者可形成化脓性胆管炎，胆源性胰腺炎，感染性休克，多脏器功能衰竭，甚至死亡等。临床比较常见的是以黄疸、腹痛还有发热等前来就诊[1]。西医治疗胆总管结石主要是通过经内镜逆行胰胆管造影术及胆总管结石取出术，但有出血、穿孔、胆道感染、急性胰腺炎等并发症。近年来中药治疗胆总管结石成为了热门，结合临床经验及文献报道，中药治疗胆石症方面有以下作用[2-4]：①增加肝脏胆汁分泌量;②促进胆囊收缩;③促进胆汁分泌及排泄，松弛Oddis括约肌;④调节胆汁中结合胆红素、非结合胆红素的比例，减少非结合胆红素;⑤调节胆汁中的胆固醇、胆酸、胆盐含量，增加亲水性胆酸含量;⑥抗感染、减轻炎症反应。故对于胆总管结石≤10 mm者，我院多采用中医中药治疗，临床治疗多予大柴胡汤合四金汤加减化裁，疗效颇著，现报道如下。, http://www.100md.com(铉力 王晓红 胡兵)