腹腔镜胆囊切除术联合茵陈蒿汤对急性结石性胆囊炎患者炎性反应递质及血清淀粉酶水平的影响
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摘要
目的:探讨腹腔镜胆囊切除术联合茵陈蒿汤对急性结石性胆囊炎患者炎性反应递质及血清淀粉酶水平的影响。方法:选取2015年6月至2017年1月眉山市中医医院收治的急性结石性胆囊炎患者112例作为研究对象,随机分为对照组和观察组,每组56例。2组患者均行腹腔镜胆囊切除术治疗,对照组术后进行常规西药治疗,观察组在对照组的基础上联合茵陈蒿汤治疗,连续治疗15 d。统计2组临床疗效;统计2组患者相关临床指标及中医证候积分变化;检测并比较治疗前后2组患者血清炎性反应递质和淀粉酶水平变化;比较2组患者术后相关并发症发生情况。结果:治疗后观察组总有效率91. 07%,较对照组的76. 79%显著升高,差异有统计学意义(P <0. 05);治疗后观察组患者肛门排气时间、下床活动时间、发热缓解时间、疼痛缓解时间及住院时间均较对照组显著缩短,差异有统计学意义(P <0. 05);与治疗前比较,治疗后2组中医证候积分显著降低,且观察组显著低于对照组,差异有统计学意义(P <0. 05);与治疗前比较,治疗后2组血清C反应蛋白(CRP)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)及淀粉酶水平均显著降低,且观察组显著低于对照组,差异有统计学意义(P <0. 05);观察组及对照组并发症总发生率分别为8. 9%及28. 6%,观察组显著低于对照组,差异有统计学意义(P <0. 05)。结论:腹腔镜胆囊切除术联合茵陈蒿汤治疗急性结石性胆囊炎可有效缓解患者临床症状,降低术后炎性反应及血清淀粉酶水平,具有较高的安全性,临床疗效显著优于术后常规治疗。
Objective: To explore the effects of laparoscopic cholecystectomy combined with Yinchenhao Decoction on the levels of serum inflammatory factor and amylase in patients with acute calculous cholecystitis. Methods: A total of 112 cases of acute calculous cholecystitis patients in Meishan Traditional Chinese Medicine Hospital from June 2015 to January 2017 were selected and randomly divided into a control group and an observation group,with 65 cases in each group. The 2 groups were treated with laparoscopic cholecystectomy. The control group was treated with conventional western medicine treatment,and observation group was treated combined with Yinchenhao Decoction on the basis of control group,for 15 days continuously. The clinical efficacy and the changes of related clinical indexes and TCM syndrome integral were statisticsed; the changes of the levels of serum inflammatory factor and amylase of 2 groups were detected and compared. The occurrence of postoperation related complications of 2 groups was compared. Results: The total effective rate of the observation group was 91. 07%,which was higher than that 76. 79% of the control group( P < 0. 05); the anus exhaust time,off-bed activity time,alleviated fever time,pain relief time and hospitalization time were shorter than those of the control group( P < 0. 01). Compared with before treatment,the TCM syndrome integrals of the 2 groups decreased significantly,and the observation group was significantly lower than control group( P < 0. 01). The serum CRP,IL-8,TNF-α and amylase levels of the 2 groups after treatment decreased significantly,and the observation group was significantly lower than the control group( P < 0. 01); The total occurrence rates of complications in the control group and the observation group were8. 9% and 28. 6% respectively,and observation group was significantly lower than the control group( P < 0. 01). Conclusion: Laparoscopic cholecystectomy combined with Yinchenhao Decoction can alleviate the clinical symptoms,reduce the postoperative inflammatory response and the serum amylase level,which has higher safety,and the clinical efficacy is better than conventional western medicine treatment postoperation.
Objective: To explore the effects of laparoscopic cholecystectomy combined with Yinchenhao Decoction on the levels of serum inflammatory factor and amylase in patients with acute calculous cholecystitis. Methods: A total of 112 cases of acute calculous cholecystitis patients in Meishan Traditional Chinese Medicine Hospital from June 2015 to January 2017 were selected and randomly divided into a control group and an observation group,with 65 cases in each group. The 2 groups were treated with laparoscopic cholecystectomy. The control group was treated with conventional western medicine treatment,and observation group was treated combined with Yinchenhao Decoction on the basis of control group,for 15 days continuously. The clinical efficacy and the changes of related clinical indexes and TCM syndrome integral were statisticsed; the changes of the levels of serum inflammatory factor and amylase of 2 groups were detected and compared. The occurrence of postoperation related complications of 2 groups was compared. Results: The total effective rate of the observation group was 91. 07%,which was higher than that 76. 79% of the control group( P < 0. 05); the anus exhaust time,off-bed activity time,alleviated fever time,pain relief time and hospitalization time were shorter than those of the control group( P < 0. 01). Compared with before treatment,the TCM syndrome integrals of the 2 groups decreased significantly,and the observation group was significantly lower than control group( P < 0. 01). The serum CRP,IL-8,TNF-α and amylase levels of the 2 groups after treatment decreased significantly,and the observation group was significantly lower than the control group( P < 0. 01); The total occurrence rates of complications in the control group and the observation group were8. 9% and 28. 6% respectively,and observation group was significantly lower than the control group( P < 0. 01). Conclusion: Laparoscopic cholecystectomy combined with Yinchenhao Decoction can alleviate the clinical symptoms,reduce the postoperative inflammatory response and the serum amylase level,which has higher safety,and the clinical efficacy is better than conventional western medicine treatment postoperation.
引文
[1]张鹏,赵大龙,高强.腹腔镜与开腹手术治疗急性结石性胆囊炎[J].肝胆外科杂志,2012,20(6):452-454.
[2]Kortram K,de Vries Reilingh TS,Wiezer MJ,et al. Percutaneous drainage for acute calculous cholecystitis[J]. Surg Endosc,2011,25(11):3642-3646.
[3]魏杰华.腹腔镜胆囊切除术联合中药治疗急性结石性胆囊炎患者疗效观察[J].亚太传统医药,2014,10(23):56-57.
[4]赵春明.大柴胡汤合茵陈蒿汤加味为主治疗急性胆囊炎62例[J].光明中医,2010,25(4):640-641.
[5]复旦大学上海医学院.实用内科学[M]. 12版.北京:人民卫生出版社,2005:267.
[6]王伯祥.肝胆病中西医诊疗学[M].北京:中国中医药出版社,2000:45.
[7]国家食品药品管理总局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:112.
[8]Gurusamy KS,Rossi M,Davidson BR. Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis[J].Cochrane Database Syst Rev,2013(8):CD007088.
[9]蔡德珺.急性结石性胆囊炎腹腔镜胆囊切除术的临床应用分析[J].世界中医药,2015,10(a02):1039-1040.
[10]钏助流.茵陈蒿汤治疗肝胆湿热型慢性胆囊炎的临床观察[J].中国保健营养,2016,26(23):135-135,136.
[11]秦双件.柴胡疏肝散合茵陈蒿汤化裁治疗慢性胆囊炎湿热血瘀证45例临床观察[J].中医药导报,2009,15(5):33-34.
[12]裴永胜.疏肝利胆汤联合腹腔镜治疗急性结石性胆囊炎30例[J].西部中医药,2014,27(8):103-104.
[13]刘兆瑞,邱正奭,吴峰.腹腔镜下胆囊切除术联合中西药物治疗胆囊结石合并胆囊炎[J].中医临床研究,2012,4(16):70-71.
[14]Curley JM,Mody RM,Gasser RA. Malaria caused by Plasmodium vivax complicated by acalculous cholecystitis[J]. Am J Trop Med Hyg,2011,85(1):42-49.
[15]周克勤.中西医结合治疗急性胆囊炎50例临床观察[J].河北中医,2013,35(5):719-720.
[16]沈旦,郭庆渠,吴育连.腹腔镜胆囊切除术对急性结石性胆囊炎患者炎症因子及血清淀粉酶水平的影响[J].肝胆胰外科杂志,2016,28(3):232-234.
[17]王权利.急性结石性胆囊炎伴急性胰腺炎的外科处理分析[D].长春:吉林大学,2013.
[18]马玉海,安中华.十五味赛尔斗丸对急性胆囊炎炎性因子和血淀粉酶同工酶水平影响的临床研究[J].河北医药,2014,36(22):3393-3395.
[2]Kortram K,de Vries Reilingh TS,Wiezer MJ,et al. Percutaneous drainage for acute calculous cholecystitis[J]. Surg Endosc,2011,25(11):3642-3646.
[3]魏杰华.腹腔镜胆囊切除术联合中药治疗急性结石性胆囊炎患者疗效观察[J].亚太传统医药,2014,10(23):56-57.
[4]赵春明.大柴胡汤合茵陈蒿汤加味为主治疗急性胆囊炎62例[J].光明中医,2010,25(4):640-641.
[5]复旦大学上海医学院.实用内科学[M]. 12版.北京:人民卫生出版社,2005:267.
[6]王伯祥.肝胆病中西医诊疗学[M].北京:中国中医药出版社,2000:45.
[7]国家食品药品管理总局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:112.
[8]Gurusamy KS,Rossi M,Davidson BR. Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis[J].Cochrane Database Syst Rev,2013(8):CD007088.
[9]蔡德珺.急性结石性胆囊炎腹腔镜胆囊切除术的临床应用分析[J].世界中医药,2015,10(a02):1039-1040.
[10]钏助流.茵陈蒿汤治疗肝胆湿热型慢性胆囊炎的临床观察[J].中国保健营养,2016,26(23):135-135,136.
[11]秦双件.柴胡疏肝散合茵陈蒿汤化裁治疗慢性胆囊炎湿热血瘀证45例临床观察[J].中医药导报,2009,15(5):33-34.
[12]裴永胜.疏肝利胆汤联合腹腔镜治疗急性结石性胆囊炎30例[J].西部中医药,2014,27(8):103-104.
[13]刘兆瑞,邱正奭,吴峰.腹腔镜下胆囊切除术联合中西药物治疗胆囊结石合并胆囊炎[J].中医临床研究,2012,4(16):70-71.
[14]Curley JM,Mody RM,Gasser RA. Malaria caused by Plasmodium vivax complicated by acalculous cholecystitis[J]. Am J Trop Med Hyg,2011,85(1):42-49.
[15]周克勤.中西医结合治疗急性胆囊炎50例临床观察[J].河北中医,2013,35(5):719-720.
[16]沈旦,郭庆渠,吴育连.腹腔镜胆囊切除术对急性结石性胆囊炎患者炎症因子及血清淀粉酶水平的影响[J].肝胆胰外科杂志,2016,28(3):232-234.
[17]王权利.急性结石性胆囊炎伴急性胰腺炎的外科处理分析[D].长春:吉林大学,2013.
[18]马玉海,安中华.十五味赛尔斗丸对急性胆囊炎炎性因子和血淀粉酶同工酶水平影响的临床研究[J].河北医药,2014,36(22):3393-3395.