柴胡排石汤胆管灌注联合十二指肠镜治疗困难胆总管结石

唐腾骞; 杨智清; 刘丹青; 欧霞; 甘浪; 张雷达

doi:10.16016/j.1000-5404.202008204

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柴胡排石汤胆管灌注联合十二指肠镜治疗困难胆总管结石

临床医学 | 更新时间：2026-01-09

- 柴胡排石汤胆管灌注联合十二指肠镜治疗困难胆总管结石
- Bile duct perfusion of Chaihu Paishi Decoction combined with duodenoscopy in treatment of difficult choledocholithiasis
- 第三军医大学学报 2021年43卷第3期页码：234-238
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院全军肝胆外科研究所
- 作者简介：
  
  [ 张雷达，E-mail:2518569931@qq.com ZHANG Leida, 2518569931@qq.com
- 基金信息：
  
  重庆市卫生计生委中医药科技项目(ZY201802095)
- DOI：10.16016/j.1000-5404.202008204
  中图分类号： R289.5;R574.51;R575.62
- 收稿：2020-08-23，
  
  修回：2020-10-28，
  
  纸质出版：2021-02-15
- 稿件说明：
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唐腾骞, 杨智清, 刘丹青, 等. 柴胡排石汤胆管灌注联合十二指肠镜治疗困难胆总管结石[J]. 第三军医大学学报, 2021,43(3):234-238.

Tengqian TANG, Zhiqing YANG, Danqing LIU, et al. Bile duct perfusion of Chaihu Paishi Decoction combined with duodenoscopy in treatment of difficult choledocholithiasis[J]. Journal of Third Military Medical University, 2021, 43(3): 234-238.
唐腾骞, 杨智清, 刘丹青, 等. 柴胡排石汤胆管灌注联合十二指肠镜治疗困难胆总管结石[J]. 第三军医大学学报, 2021,43(3):234-238. DOI： 10.16016/j.1000-5404.202008204.

Tengqian TANG, Zhiqing YANG, Danqing LIU, et al. Bile duct perfusion of Chaihu Paishi Decoction combined with duodenoscopy in treatment of difficult choledocholithiasis[J]. Journal of Third Military Medical University, 2021, 43(3): 234-238. DOI： 10.16016/j.1000-5404.202008204.

摘要

目的

探讨柴胡排石汤胆管灌注联合十二指肠镜治疗困难胆总管结石的临床有效性及安全性。

方法

纳入2018年8月至2020年1月本院困难胆总管结石患者60例，采用前瞻性随机对照研究分为试验组和对照组各30例。试验组行十二指肠镜下鼻胆管引流术，经鼻胆管注入20~50 mL柴胡排石汤，夹闭鼻胆管末端2 h后通畅引流，上述方法每日3次，共10 d。对照组以相同容积的生理盐水以同样的方法注入。观察胆总管结石溶解、裂解与取石效果等情况，在第10天复查B超及取石治疗。

结果

试验组结石溶解、裂解率明显高于对照组(

0.01)，手术时间和术中出血量均低于对照组(

0.01)，结石一次取尽率高于对照组(

0.05)。与对照组相比，试验组未增加术后并发症的发生率。

结论

柴胡排石汤胆管灌注联合十二指肠镜治疗困难胆总管结石安全、有效，为中西医结合治疗困难胆总管结石提供了新的依据。

Abstract

Objective

To investigate the clinical efficacy and safety of Chaihu Paishi Decoction through bile duct perfusion combined with duodenoscopy in the treatment of difficult choledocholithiasis.

Methods

A prospective randomized controlled study was carried out on the patients with difficult choledocholithiasis admitted in our department from August 2018 to January 2020. They were randomly divided into an experimental group and a control group

with 30 cases in each group. In the experimental group

20~50 mL Chaihu Paishi Decoction was injected into the nasobiliary duct under the guidance of duodenoscopy

and the end of the duct was clamped for 2 h. The above treatment was given 3 times per day

for 10 d. The control group was treated with normal saline in the same way. The stone dissolution

lysis rate and stone remove were observed to evaluate the efficiency. On the 10th day

ultrasound examination was performed

and duodenoscopy was carried out.

Results

The stone dissolution and lysis rates were significantly higher in the experimental group than those in the control group (

0.01). The experimental group had obviously shorter operation time and less blood loss (

0.01) and notably higher one-shot stone removal rate (

0.05) when compared with the control group. The experimental group did not differ from the other group in the incidence of postoperative acute pancreatitis.

Conclusion

Chaihu Paishi Decoction through bile duct perfusion combined with duodenoscopy is safe and effective in the treatment of difficult common bile duct stones

which provides a new basis for the treatment in combination with traditional Chinese and Western medicine.

关键词

Keywords

references

中华医学会消化内镜分会ERCP学组. ERCP诊治指南(2010版)[J].中华消化内镜杂志, 2010, 27(3): 113-118.

ERCP Group of Digestive Endoscopy Branch of Chinese Medical Association. Guidelines for the diagnostic and therapeutic ERCP(2010)[J]. Chin J Diges Endosc, 2010, 27(3): 113-118.

吴炎炎, 燕善军. ERCP取石术后胆总管结石复发因素研究进展[J].胃肠病学和肝病学杂志, 2020, 29(1):108-111.

WU Y Y, YAN S J.Research progress of recurrence factors of bile duct stones after ERCP[J]. Chin J Gastroenter Hepatol, 2020, 29(1):108-111.

林树文, 方颖华, 袁智明, 等. 3镜联合同期治疗内镜取石失败的胆道结石[J].中国内镜杂志, 2016, 22(3): 101-104.

LIN S W, FANG Y H, YUAN Z M, et al . Synchronous treatment of combined choledochoscopy, duodenoscopy and laparoscopy for management-failed biliary calculi[J ] . China J Endosc, 2016, 22(3): 101-104.

BINMOELLER K F, BRVCKNER M, THONKE F, et al . Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy[J ] . Endoscopy, 1993, 25(3): 201-206. DOI:10.1055/s-2007-1010293.

SACKMANN M, HOLL J, SAUTER G H, et al . Extracorporeal shock wave lithotripsy for clearance of bile duct stones resistant to endoscopic extraction[J ] . Gastrointest Endosc, 2001, 53(1): 27-32. DOI:10.1067/mge.2001.111042.

陈增银, 王存涛, 史光军.胆道镜钬激光与液电碎石治疗肝内胆管结石的效果比较[J].中华肝胆外科杂志, 2019, 025(002):124-126.

CHEN Z Y, WANG C T, SHI G J. Effect of holmium laser and hydroelectric lithotripsy under choledochoscopy for complicated intrahepatic bile duct stones[J]. Chin J Hepatobiliary Surg, 2019, 025(002):124-126.

JIANG J T, LI W G, ZHU Y P, et al . Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections[J ] . Lasers Med Sci, 2016, 31(5): 915-920. DOI:10.1007/s10103-016-1932-9.

TINNE N, KNOOP G, KALLWEIT N, et al . Effects of cavitation bubble interaction with temporally separated fs-laser pulses[J ] . J Biomed Opt, 2014, 19(4): 048001. DOI:10.1117/1.jbo.19.4.048001.

王宏光.胆总管结石内镜治疗进展[J].肝胆外科杂志, 2004, 12(4): 312-314.

WANG H G. The progressof endoscopic treatment of choledocholithiasis. J Hepatobiliary Surg, 2004, 12(4): 312-314.

TANDAN M N. Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones[J]. World J Gastroenterol, 2011, 17(39): 4365. DOI:10.3748/wjg.v17.i39.4365.

MURATORI R, AZZAROLI F, BUONFIGLIOLI F, et al . ESWL for difficult bile duct stones: a 15-year single centre experience[J ] . World Journal of Gastroenterology, 2010, 16(33): 4159-4163.

DARISETTY S. Epidural anesthesia is effective for extracorporeal shock wave lithotripsy of pancreatic and biliary calculi[J]. World J Gastrointest Surg, 2010, 2(5): 165. DOI:10.4240/wjgs.v2.i5.165.

王和天, 刘殿池, 赵荣莱.胆石症的中医病因病机[J].世界华人消化杂志, 2001, 9(9): 1031-1033.

WANG H T, LIU D C, ZHAO R L. TCM etiology and pathogenesis of cholelithiasis. World Chin J Dig, 2001, 9(9): 1031-1033.

郑少翰.中西医结合治疗肝内胆管结石56例[J].福建中医药, 2005, 36(4): 24.

ZHENG S H. 10 Cases of Intrahepatic Bile Duct Stones Treated by Integrated Traditional Chinese and Western Medicine. Fujian J Tradit Chin Med, 2005, 36(4): 24.

黄坚, 熊风珍, 王峻, 等.胆道排石合剂治疗肝内三级以上胆管结石42例临床分析[J].广州中医药大学学报, 2005, 22(3): 188-190.

HUANG J, XIONG F Z, WANG J, et al . Effects of Dandao Paishi mixture for the treatment of the third-level or above intrahepatic biliary duct stone: an observation of 42 cases[J ] . J Guangzhou Univ Tradit Chin Med, 2005, 22(3): 188-190.

董必文.柴胡溶石颗粒治疗胆石症临床研究[J].亚太传统医药, 2012, 8(1): 65-67.

DONG B W. a clinical study on treating cholelithiasis with chaihurongshigranules[J]. Asia-Pac Tradit Med, 2012, 8(1): 65-67.

唐蓉珠, 尚静娟, 董跃滨.柴胡排石汤方剂萃取物的溶石效果研究[J].中国急救医学, 2016, 36(1):115-116.

TANG R Z, SHANG J J, DONG Y B. Study on the dissolving effect of the extract of Chaihu Paishi Decoction[J]. Chin J Crit Care Med, 2016, 36(1):115-116.

DUMONCEAU J M, ANDRIULLI A, DEVIERE J, et al . European society of gastrointestinal endoscopy (ESGE)guideline: prophylaxis of post-ERCP pancreatitis[J ] . Endoscopy, 2010, 42(6): 503-515. DOI:10.1055/s-0029- 1244208.

侯延平, 郭玉青, 谭明仪.利胆排石汤对胆总管结石ERCP取石术后急性胰腺炎防治作用的研究[J].湖北中医杂志, 2008, 30(6): 32-33.

HOU Y P, GUO Y Q, TAN M Y. Study of Lidan Paishi Decoction on the Prevention and Treatment of Acute Pancreatitis after ERCP Removal of Common Bile Duct Stones[J]. Hubei J Tradit Chin Med, 2008, 30(6): 32-33.

单连云, 朱本贵, 时桂芹, 等.柴芍承气汤对内镜下逆行胰胆管造影术后胰腺炎的预防作用[J].现代中西医结合杂志, 2010, 19(17): 2120-2121.

SHAN L Y, ZHU B G, SHI G Q, et al . The Preventive Effect of Chaishao Chengqi Decoction on Pancreatitis after Endoscopic Retrograde Cholangiopancreatography[J ] . Mod J Integr Chin Tradit West Med, 2010, 19(17): 2120-2121.

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