中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

清热利胆颗粒预防腹腔镜联合胆道镜术后胆总管结石复发的效果分析

李积强 齐清会 张桂信

引用本文:
Citation:

清热利胆颗粒预防腹腔镜联合胆道镜术后胆总管结石复发的效果分析

DOI: 10.3969/j.issn.1001-5256.2023.10.020
基金项目: 

国家自然科学基金 (82174136);

辽宁省卫健委中医药临床重点专科能力建设项目 (LiaoNing Health Office 2019(169))

伦理学声明:本研究方案于2021年12月24日经由大连医科大学附属第一医院伦理委员会审核批准,批号:PJ-KS-KY-2021-282。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:李积强负责临床数据收集、随访、分析及撰写论文;齐清会负责论文的审核及修改;张桂信负责拟定写作思路,指导撰写文章并最终定稿。
详细信息
    通信作者:

    ‍张桂信, zgx@126.com (ORCID: 0000-0002-6171-394X)

Clinical effect of Qingre Lidan granules in preventing the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy

Research funding: 

National Natural Science Foundation of China (82174136);

Key Clinical Specialty Capacity Building Project of TCM of LiaoNing Provincial Health Commission (LiaoNing Health Office 2019(169))

More Information
    Corresponding author: ZHANG Guixin, zgx@126.com (ORCID: 0000-0002-6171-394X)
  • 摘要:   目的  通过回顾性队列研究分析中药清热利胆颗粒对于腹腔镜联合胆道镜术后胆总管结石复发的预防作用。  方法  纳入大连医科大学附属第一医院2010年1月1日—2020年12月31日行腹腔镜联合胆道镜取石术治疗的胆总管结石(含合并胆囊结石)住院患者共337例。收集患者相关临床资料,并依据随访结果将患者分为暴露组(常规治疗+清热利胆颗粒组)225例与非暴露组(常规治疗组)112例,详细记录两组患者结石复发的相关情况以及中药清热利胆颗粒的服用情况。观察两组患者胆总管结石的复发率及结石复发的时间,并分析胆总管结石复发的危险因素。计量资料符合正态分布时两组间比较采用成组t检验,不符合正态分布时两组间比较采用Mann-Whithey U检验;计数资料两组间比较采用χ2检验或Fisher确切概率法。使用Kaplan-Meier曲线估计两组患者胆总管结石复发的累积概率,两组间比较采用Log-rank检验。  结果  腹腔镜联合胆道镜术后胆总管结石复发26例,其中暴露组12例(5.33%),非暴露组14例(12.5%),暴露组复发率较非暴露组明显降低(χ2=5.394,P=0.020)。暴露组患者结石复发的平均时间为(40.1±26.7)个月,较非暴露组患者的结石复发平均时间(19.2±13.5)个月明显延长(t=2.383,P=0.017)。Kplan-Meier曲线分析显示非暴露组患者不同时间段的累积复发率均高于暴露组(P<0.05)。多因素Logistic回归分析显示胆总管直径≥14 mm(OR=2.935,P=0.031)与多发结石(OR=2.911,P=0.029)是腹腔镜联合胆道镜取石术后胆总管结石复发的独立危险因素。  结论  清热利胆颗粒可以有效降低腹腔镜联合胆道镜术后胆总管结石的复发率,并延长结石复发的时间,具有一定的预防术后结石复发的作用。

     

  • 图  1  暴露组与非暴露组累积复发率曲线图

    Figure  1.  Kaplan-Meier chart of cumulative recurrence rates in exposed and non-exposed groups

    表  1  暴露组与非暴露组患者基线资料比较

    Table  1.   Comparison of baseline data between exposed group and non-exposed group

    基线资料 暴露组(n=225) 非暴露组(n=112) 统计值 P
    男[例(%)] 114(50.7) 60(53.6) χ 2=0.253 0.615
    年龄(岁) 64.3 ± 14.2 61.3 ± 13.4 t=1.870 0.062
    既往疾病史[例(%)]
    高血压 72(32.0) 32(28.6) χ 2=0.412 0.521
    糖尿病 40(17.8) 15(13.4) χ 2=1.053 0.305
    冠心病 18(8.0) 6(5.4) χ 2=0.790 0.374
    肝硬化 2(0.9) 1(0.9) χ 2=0.001 >0.05
    慢性肾衰竭 3(1.3) 1(0.9) χ 2=0.002 >0.05
    急性胆管炎 68(30.2) 35(31.3) χ 2=0.073 0.847
    胆道手术史[例(%)]
    经皮肝胆囊穿刺引流术(PTGD) 21(9.3) 7(6.3) χ 2=0.933 0.334
    经皮肝胆管穿刺引流术(PTCD) 4(1.8) 3(2.7) χ 2=0.020 0.888
    住院时间(天) 13.7 ± 6.2 15.5 ± 5.9 t=-2.552 0.011
    随访时间(月) 55.43 ± 22.16 80.73 ± 31.61 t=-7.593 <0.001
    胆总管闭合方式[例(%)]
    一期缝合 64(28.4) 22(19.6) χ 2=3.048 0.081
    T管引流 161(71.6) 90(80.4)
    取石方式[例(%)]
    经胆囊管切开取石 33(14.7) 10(8.9) χ 2=2.212 0.137
    经胆总管切开取石 192(85.3) 102(91.1)
    胆总管最大直径(cm) 12.6 ± 3.9 13.6 ± 5.2 t=-1.460 0.144
    结石最大直径(cm) 10.2 ± 5.6 10.5 ± 5.8 t=-0.506 0.613
    结石数量[例(%)]
    单发 109(48.4) 45(40.2) χ 2=2.059 0.151
    多发(≥2枚) 116(23.2) 67(59.8)
    T管拔除时间(天) 74.8 ± 18.2 78.7 ± 15.2 t=-1.727 0.085
    入院实验室检查
    WBC(×109/L) 7.84 ± 4.16 9.31 ± 5.77 t=-0.448 0.669
    ALT(U/L) 134(42~281) 143(58~309) Z=-1.110 0.267
    AST(U/L) 76(32~178) 86(41~171) Z=-0.537 0.594
    ALP(U/L) 211.2 ± 137.1 194.5 ± 141.0 t=-2.355 0.559
    GGT(U/L) 271(96~526) 409(207~621) Z=-3.069 0.002
    DBil(μmol/L) 15.3(7.4~38.5) 18.4(9.1~45.6) Z=-1.700 0.089
    TBil(μmol/L) 29.0(16.8~70.1) 34.6(22.2~77.4) Z=-1.877 0.058
    下载: 导出CSV

    表  2  暴露组与非暴露组患者复发情况比较

    Table  2.   Comparison of recurrence rate between exposed group and non-exposed group

    项目 暴露组(n=225) 非暴露组(n=112) 统计值 P
    复发率[例(%)] 12(5.33) 14(12.5) χ 2=5.394 0.020
    复发时间(月) 40.1 ± 26.7 19.2 ± 13.5 t=2.383 0.017
    下载: 导出CSV

    表  3  LCBDE术后胆总管结石复发的影响因素分析

    Table  3.   Analysis of influencing factors of choledocholithiasis recurrence after laparoscopy combined with choledochoscopy

    影响因素 单因素Logistic分析 多因素Logistic分析
    P OR(95%CI) P OR(95%CI)
    性别(男) 0.814 1.101(0.494~2.465)
    年龄(>65岁) 0.153 1.829(0.791~4.228)
    糖尿病史 0.128 2.019(0.805~5.063)
    高血压病史 0.935 0.981(0.412~2.333)
    急性胆管炎病史 0.388 0.662(0.258~1.700)
    胆总管最大直径(≥14 mm) 0.000 4.230(1.821~9.829) 0.031 2.935(1.101~7.829)
    结石数量(≥2枚) 0.019 2.949(1.153~7.544) 0.029 2.911(1.118~7.584)
    结石最大直径(≥15 mm) 0.002 3.513(1.547~7.978) 0.142 2.060(0.784~5.411)
    T管引流 0.048 2.791(1.010~7.273)
    PTGD手术史 0.893 0.702(0.159~3.105)
    经胆总管切开取石 0.085 0.084(0.817~9.540)
    下载: 导出CSV
  • [1] CIANCI P, RESTINI E. Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches[J]. World J Gastroenterol, 2021, 27( 28): 4536- 4554. DOI: 10.3748/wjg.v27.i28.4536.
    [2] HORI T. Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation[J]. World J Gastroenterol, 2019, 25( 13): 1531- 1549. DOI: 10.3748/wjg.v25.i13.1531.
    [3] YAN Y, SHA Y, YUAN W, et al. One-stage versus two-stage management for acute cholecystitis associated with common bile duct stones: a retrospective cohort study[J]. Surg Endosc, 2022, 36( 2): 920- 929. DOI: 10.1007/s00464-021-08349-6.
    [4] RICCI C, PAGANO N, TAFFURELLI G. et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: A systematic review and network Meta-analysis[J]. JAMA Surg, 2018, 153( 7): e181167. DOI: 10.1001/jamasurg.2018.1167.
    [5] LI ZQ, SUN JX, LI B, et al. Meta-analysis of single-stage versus two-staged management for concomitant gallstones and common bile duct stones[J]. J Minim Access Surg, 2020, 16( 3): 206- 214. DOI: 10.4103/jmas.JMAS_146_18.
    [6] VAKAYIL V, KLINKER ST, SULCINER ML, et al. Single-stage management of choledocholithiasis: intraoperative ERCP versus laparoscopic common bile duct exploration[J]. Surg Endosc, 2020, 34( 10): 4616- 4625. DOI: 10.1007/s00464-019-07215-w.
    [7] CAHYADI O, TEHAMI N, DE-MADARIA E, et al. Post-ERCP pancreatitis: Prevention, diagnosis and management[J]. Medicina(Kaunas), 2022, 58( 9): 1261. DOI: 10.3390/medicina58091261.
    [8] ZHU J, WANG G, XIE B, et al. Minimally invasive management of concomitant gallstones and common bile duct stones: an updated network meta-analysis of randomized controlled trials[J]. Surg Endosc, 2023, 37( 3): 1683- 1693. DOI: 10.1007/s00464-022-09723-8.
    [9] MANSOUR S, KLUGER Y, KHURI S. Primary recurrent common bile duct stones: Timing of surgical intervention[J]. J Clin Med Res, 2022, 14( 11): 441- 447. DOI: 10.14740/jocmr4826.
    [10] CHEN XP, WANG JP. Surgery[M]. Eighth Edition. Beijing: People’s Medical Publishing House, 2018: 440- 441.

    陈孝平, 汪建平. 外科学[M]. 8版. 北京: 人民卫生出版社, 2018: 440- 441.
    [11] YOO ES, YOO BM, KIM JH, et al. Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy[J]. Scand J Gastroenterol, 2018, 53( 4): 466- 470. DOI: 10.1080/00365521.2018.1438507.
    [12] WANG YF, XU B, WANG J, et al. Clinical effect of laparoscopy,choledochoscopy,and duodenoscopy combined with T-tube-free drainage in treat-ment of gallstones with common bile duct stones[J]. J Clin Hepatol, 2021, 37( 4): 872- 876. DOI: 10.3969/j.issn.1001-5256.2021.04.029.

    王云峰, 徐斌, 王杰, 等. 腹腔镜、胆道镜及十二指肠镜联合免T管引流对胆囊结石合并胆总管结石的治疗效果分析[J]. 临床肝胆病杂志, 2021, 37( 4): 872- 876. DOI: 10.3969/j.issn.1001-5256.2021.04.029.
    [13] LEE SJ, CHOI IS, MOON JI, et al. Optimal treatment for concomitant gallbladder stones with common bile duct stones and predictors for recurrence of common bile duct stones[J]. Surg Endosc, 2022, 36( 7): 4748- 4756. DOI: 10.1007/s00464-021-08815-1.
    [14] ZENG SM, LIU XR, LI SF, et al. Research progress of traditional Chinese medicine in the treatment of cholelithiasis[J]. J Chin Med Pharm, 2020, 48( 9): 72- 76. DOI: 10.19664/j.cnki.1002-2392.200166.

    曾思敏, 刘熙荣, 李生发, 等. 中医药治疗胆石症的研究进展[J]. 中医药学报, 2020, 48( 9): 72- 76. DOI: 10.19664/j.cnki.1002-2392.200166.
    [15] ZHANG Y, ZHENG L. Experience of zheng liang in the treatment of cholelithiasis[J/CD]. Cardiov Dis Electronic J Integr Tradit Chin Western Med, 2019, 7( 31): 167- 168.

    张怿, 郑亮. 郑亮治疗胆石症临证经验[J/CD]. 中西医结合心血管病电子杂志, 2019, 7( 31): 167- 168.
    [16] HU SW, ZHANG W, DING QY, et al. Econstruction of Chinese Materia Medica-Herba Lysimachiae[J]. J Changchun Univ Chin Med, 2023, 39( 5): 476- 479. DOI: 10.13463/j.cnki.cczyy.2023.05.002.

    胡诗宛, 张伟, 丁齐又, 等. 重构本草——金钱草[J]. 长春中医药大学学报, 2023, 39( 5): 476- 479. DOI: 10.13463/j.cnki.cczyy.2023.05.002.
    [17] NIJIATIJIANG ABBL, ALIMUJIANG ABLMT, ALIDAN AKE, et al. Efficacy of LC combinedwith LCHTD in treatment of choledocholithiasis complicated with cholecystolithiasis and the related factors of postoperative recurrence of choledocholithiasis[J]. J Hepatopancreatobiliary Surg, 2021, 33( 7): 419- 422. DOI: 10.11952/j.issn.1007-1954.2021.07.007.

    尼加提江·艾比不拉, 阿力木江·阿布力米提, 阿里旦·艾尔肯, 等. LC联合LCHTD治疗胆总管结石合并胆囊结石的效果及术后胆总管结石复发的相关因素分析[J]. 肝胆胰外科杂志, 2021, 33( 7): 419- 422. DOI: 10.11952/j.issn.1007-1954.2021.07.007.
    [18] LYU YH, ZHANG HC, SONG CY, et al. Logistic regression analysis of related factors of stone recurrence after laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage[J]. Chongqing Med J, 2016, 45( 9): 1262- 1264. DOI: 10.3969/j.issn.1671-8348.2016.09.033.

    吕运海, 张焕常, 宋朝阳, 等. 腹腔镜胆囊切除联合胆总管切开取石T管引流术后结石复发相关因素的Logistic回归分析[J]. 重庆医学, 2016, 45( 9): 1262- 1264. DOI: 10.3969/j.issn.1671-8348.2016.09.033.
    [19] PENG LJ, CHENG XN, ZHANG L. Risk factors of stone recurrence after endoscopic retrograde cholangiopancreatography for common bile duct stones[J]. Medicine(Baltimore), 2020, 99( 27): e20412. DOI: 10.1097/MD.0000000000020412.
    [20] MENG H. Risk factors for recurrent choledocholithiasis after ERCP lithotomy[J]. Hebei Med, 2016, 38( 5): 716- 718. DOI: 10.3969/j.issn.1002-7386.2016.05.025.

    孟环. ERCP取石后胆总管结石复发的相关危险因素研究[J]. 河北医药, 2016, 38( 5): 716- 718. DOI: 10.3969/j.issn.1002-7386.2016.05.025.
    [21] PARK SY, HONG TH, LEE SK, et al. Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study[J]. J Hepatobiliary Pancreat Sci, 2019, 26( 12): 578- 582. DOI: 10.1002/jhbp.675.
    [22] HUANG P, KE H, QIU Y, et al. Systematically characterizing chemical profile and potential mechanisms of qingre lidan decoction acting on cholelithiasis by integrating UHPLC-QTOF-MS and network target analysis[J]. Evid Based Complement Alternat Med, 2019, 2019: 2675287. DOI: 10.1155/2019/2675287.
    [23] FANG BJ, SHEN JY, ZHANG H, et al. Effect of emodin on mobility signal transduction system of gallbladder smooth muscle in Guinea pig with cholelithiasis[J]. Asian Pac J Trop Med, 2016, 9( 10): 1013- 1018. DOI: 10.1016/j.apjtm.2016.07.021.
    [24] CAO LP, JIN HL, HONG Y, et al. Effect of kaempferol solid dispersion on cholestatic liver injury induced by α-naphthalene isothiocyanate in rats[J]. J Chin Med Materls, 2022, 45( 7): 1740- 1743. DOI: 10.13863/ j.ssn1001-4454.

    曹丽萍, 金红柳, 洪晔, 等. 山柰酚固体分散体对α-萘异硫氰酸诱导大鼠胆汁淤积性肝损伤的影响[J]. 中药材, 2022, 45( 7): 1740- 1743. DOI: 10.13863/j.issn1001-4454.
    [25] WANG Y, ZHANG C, FENG JG. Effect of emodin on cholesterol stone formation[J]. Shaanxi Med J, 2016, 45( 6): 656- 658. DOI: 10.3969/j.issn.1000-7377.2016.06.005.

    王羊, 张成, 冯金鸽. 大黄素影响胆固醇结石形成的实验研究[J]. 陕西医学杂志, 2016, 45( 6): 656- 658. DOI: 10.3969/j.issn.1000-7377.2016.06.005.
    [26] DING Y, XIONG XL, ZHOU LS, et al. Preliminary study on Emodin alleviating alpha-naphthylisothiocyanate-induced intrahepatic cholestasis by regulation of liver farnesoid X receptor pathway[J]. Int J Immunopathol Pharmacol, 2016, 29( 4): 805- 811. DOI: 10.1177/0394632016672218.
    [27] TU JX, HUANG WR, HE CJ, et al. Protective effect of quercetin on cholestasis induced by 17α-acetylidiol[J]. Zhejiang Med J, 2020, 42( 17): 1802- 1808. DOI: 10.12056/j.issn.1006-2785.2020.42.17.2019-3898.

    涂君雪, 黄婉然, 何储君, 等. 槲皮素对17α-乙炔雌二醇诱导胆汁淤积的肝保护作用研究[J]. 浙江医学, 2020, 42( 17): 1802- 1808. DOI: 10.12056/j.issn.1006-2785.2020.42.17.2019-3898.
    [28] ZHANG M, XIE Z, GAO W, et al. Quercetin regulates hepatic cholesterol metabolism by promoting cholesterol-to-bile acid conversion and cholesterol efflux in rats[J]. Nutr Res, 2016, 36( 3): 271- 279. DOI: 10.1016/j.nutres.2015.11.019.
    [29] VOVKUN T, YANCHUK P, SHTANOVA L, et al. Water-soluble quercetin modulates the choleresis and bile lipid ratio in rats[J]. Gen Physiol Biophys, 2018, 37( 1): 111- 120. DOI: 10.4149/gpb_2017015.
    [30] KLINE L. The flavone luteolin, an endocrine disruptor, relaxed male guinea pig gallbladder strips[J]. Gastroenterology Res, 2019, 12( 2): 53- 59. DOI: 10.14740/gr1142.
  • 加载中
图(1) / 表(3)
计量
  • 文章访问数:  291
  • HTML全文浏览量:  103
  • PDF下载量:  32
  • 被引次数: 0
出版历程
  • 收稿日期:  2023-02-06
  • 出版日期:  2023-10-30
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回