王 刚（四川省成都三六三医院，四川 成都 610041）



胆道镜下钛激光碎石及逆冲洗配合中药治疗难取性胆管结石疗效分析

王 刚
（四川省成都三六三医院，四川 成都 610041）

［摘 要］目的：观察胆道镜下钛激光碎石及逆冲洗配合中药治疗难取性胆管结石的临床疗效。方法：74例随机分为治疗组和对照组各 37 例。两组均采用胆道镜下钛激光碎石结合逆冲洗术，治疗组加用疏肝利胆排石汤治疗。结果：痊愈率、显效率、有效率治疗组分别为78．38%、29．73%、16．22%，对照组分别为59．46%、18．92%、8．11%，治疗组疗效优于对照组（P＜0．05）；住院时间、胆石残留率、复发率治疗组分别为（13±3．6）天、21．62%、10．81%，对照组分别为（18±4．9）天、40．54%、24．32%，两组比较差异均有统计学意义（P＜0．05）。结论：疏肝利胆排石汤联合胆道镜下钛激光碎石结合逆冲洗治疗胆管结石疗效显著，优于单纯手术治疗，可缩短住院时间、降低胆石残留率和复发率。

［关键词］难取性胆管结石；胆道镜下钛激光碎石；逆冲洗；疏肝利胆排石汤

［Abstract］Objective：To observe the clinical curative effect of Shugan Lidan Paishi Decoction combined with cholangioscopy holmium laser lithotripsy with inverse flush in treating refractory bile duct stones．Method：74 cases of cholelithiasis patients were randomly divided into two groups，with 37 cases in each group．The two groups were given optic choledochoscope holmium laser lithotripsy with inverse flush surgery. The treatment group were treated with Shugan Lidan Paishi Decoction additionally. Result：The recovery rate， obvious effective rate ， efficacy rate of the treatment group were 78.38%，29.73%， 16.22% respectively while that of the control group was 59.46%， 18.92%， 8.11%， which of the treatment group was superior to that of the control group（P＜0.05）. The hospitalization time， the residual rate of gallstone and the recurrence rate of the treatment group were （13±3.6）d， 10.81%，21.62% respectively while that of the control group were （18±4.9），40.54%， 24.32% respectively， which of the treatment group was superior to that of the control group（P＜0.05）.Conclusion：Shugan Lidan Paishi Decoction combined with optic choledochoscope holmium laser lithotripsy with inverse flush has significant curative effect on cholelithiasis ， better than simple surgery. It could shorten the length of hospital stay， reduce the residual stone rate and the recurrence rate.

［Key Words］ Refractory bile duct stones；Cholangioscopy；Holmium laser lithotripsy；Inverse flush；Shugan Lidan Paishi Decoction

肝内胆管结石属于普通外科疾病中的常见病与多发病，在肝胆管结石治疗上，治愈肝胆管结石和预防结石再发已成为当下治疗的重点［1-2］。手术是目前治疗肝胆管结石的首选治疗方法，随着纤维胆管镜及配套碎石仪器的应用，明显提高了肝胆管结石的治疗效果［3］，但存在术后残留率较高，部分患者需多次手术才能取净以及术后易复发的问题。研究表明［4-6］，在中医理论指导下，术后辨证应用中药治疗能促进残留结石排出﹑缓解术后并发症﹑降低术后复发率，提高临床疗效。……