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首页 > 期刊列表 > 联合应用利胆排石药物治疗胆总管细小结石可行性分析
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标题: 联合应用利胆排石药物治疗胆总管细小结石可行性分析
摘要:

目的:探讨联合应用利胆、排石药物对胆总管细小结石的治疗作用,以期提高其非手术治疗效果。 方法:回顾性分析2014年11月至2018年1月北京电力医院联合应用利胆(33%硫酸镁)、排石(颠茄片、山莨菪碱)药物治疗41例胆总管细小结石(直径≤8 mm,数量≤3个)患者的临床资料。 结果:41例患者排石成功率为73.17%(30/41),其中排石成功组30例(合并急性胆囊炎2例,6.67%),排石数量为1~3(1.1±0.4)?个,排石时间为3~16(6.0±3.7)?d,住院时间为3~23(12.7±5.2)?d,排石失败组11例(合并急性胆囊炎5例,45.45%),排石数量为1~2(1.2±0.4)个,排石时间为5~14(9.4±3.5)d,住院时间为10~23(15.8±4.1)d,两组排石数量及住院时间对比,差异无统计学意义(t=0.086,P=0.032;t=2.014,P=0.051),但排石失败组合并急性胆囊炎比例较高,排石时间明显延长(χ2=6.033,P=0.024;t=2.522,P=0.016)。排石成功组患者排石后的肝功能指标如丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、结合胆红素(DBil)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP),均较排石前显著降低(t=3.369、4.957、5.112、5.231、2.264、2.422,均P<0.05)。随访6~18个月,41例患者肝功能正常,均无胆总管结石复发或再生。 结论:联合应用利胆、排石药物可促进胆总管细小结石排入十二指肠,降低手术治疗胆总管细小结石概率,既可作为胆总管细小结石的非手术治疗方法,又可作为胆总管结石的术前准备措施,以期最大限度地简化治疗手段,减轻患者痛苦,减少治疗隐患。

英文摘要: Objective:To explore the therapeutic effects of small choledocholithiasis treated with the combination of choleretic and calculus-removal drugs, so as to improve the effect of non-operative treatment of small choledocholithiasis. Methods:The clinical data of forty-one patients with common bile duct calculi (diameter≤8 mm, number≤3) treated with choleretic (33% magnesium sulfate) and lithotripsy (belladonna tablets, anisodamine) in Beijing Electric Power Hospital from November 2014 to January 2018 were retrospectively analyzed. Results:The successful rate of stone removal in 41 patients was 73.17%(30/41), of which 30 cases (including 2 cases with acute cholecystitis) were successful group, and 11 cases (including 5 cases with acute cholecystitis) were failure group. Comparison of two groups with acute cholecystitis, stone discharge, stone discharge time and hospital stay showed no significant differences in stone discharge [1-3 (1.1±0.4) vs 1-2 (1.2±0.4), t=0.086, P=0.032] and hospital stay [3-23 (12.7±5.2) d vs 10-23 (15.8±4.1) d, t=2.014, P=0.051], while the failure group had a higher proportion of acute cholecystitis (45.45% vs 6.67%, χ2=6.033, P=0.024) and the time of lithotripsy was significantly prolonged [5-14 (9.4±3.5) d vs 3-16 (6.0±3.7) d, t=2.522, P=0.016]. The liver function indexes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), conjugated bilirubin (DBil), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) after lithotripsy in the successful group were significantly lower than those before lithotripsy (t=3.369, 4.957, 5.112, 5.231, 2.264, 2.422; all P<0.05). After 6-18 months of follow-up, all 41 patients had normal liver function and no recurrence or regeneration of common bile duct stones. Conclusion:The combined administration of choleretic and lithagogue drugs can promote the small choledocholithiasis into duodenum, reduce the chance of surgical treatment of small choledocholithiasis, not only as a non-operative treatment for the small choledocholithiasis, but also as a preoperative preparatory measure for the choledocholithiasis, so as to maximize the simplification of treatment, reduce patient pain, decrease treatment risks and avoid unnecessary surgery.
作者:

刘立民;张宗明;张翀;刘卓;于宏伟;朱明文

作者单位: 首都医科大学北京电力医院普外科
期刊: 中华普通外科学文献(电子版)
年.卷(期):页码 2019 .13(3):202-207
中图分类号:
文章编号:
引用格式: [1]刘立民;张宗明;张翀;刘卓;于宏伟;朱明文.联合应用利胆排石药物治疗胆总管细小结石可行性分析[J/CD].中华普通外科学文献(电子版),2019,13(3):202-207 .
关键词: 胆总管结石;利胆药和促胆汁分泌药;排石;药物疗法, 联合用药
英文关键词: Choledocholithiasis;Cholagogues and choleretics;Calculus-removal;Drug therapy;Combination

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