發(fā)布時(shí)間：2018-03-23 23:17

  本文選題：膽管巨大結(jié)石　切入點(diǎn)：ERCP　出處：《遼寧中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的:對比觀察ERCP術(shù)后置入鼻膽管注入加減化石利膽湯對經(jīng)EST/EPLBD等術(shù)后因手術(shù)難度高、操作次數(shù)多、手術(shù)時(shí)間長及患者因身體狀況差等原因無法順利取出全部結(jié)石的情況下對肝外膽管巨大結(jié)石進(jìn)一步采用溶石治療的療效。材料與方法:本組30例均為來自沈陽軍區(qū)總醫(yī)院內(nèi)鏡科與中醫(yī)科2011年8月至2013年7經(jīng)ERCP術(shù)證實(shí)為膽總管巨大結(jié)石并于術(shù)中無法一次性取出的膽總管巨大結(jié)石、嵌頓型結(jié)石及充滿性結(jié)石留置鼻膽管的患者30例,隨機(jī)分為2組,實(shí)驗(yàn)組(n=15)男8例,女7例,53-89歲,平均年齡68.25歲。在常規(guī)抗感染、抑酸、抑酶、保肝等西醫(yī)治療基礎(chǔ)上術(shù)后第一天開始經(jīng)鼻膽管緩慢推注20-50ml“加減化石利膽湯”,封閉鼻膽管末端2h,每日2次,共30天;對照組(n=15)男7例,女8例,46-83歲,平均年齡67.78歲,在上述基礎(chǔ)上以同樣的方法給予生理鹽水對照。觀察兩組患者第30天超聲及ERCP術(shù)中膽總管內(nèi)徑及結(jié)石的變化情況。結(jié)果:所有患者在開始接受治療中藥溶石治療后接受超聲及ERCP術(shù)復(fù)查,實(shí)驗(yàn)組超聲下第30天膽總管內(nèi)徑為0.69±0.63cm,對照組為2.84±0.80cm;(P0.01);第二次ERCP(30天)中發(fā)現(xiàn),實(shí)驗(yàn)組與對照組完全溶石例數(shù)分別為9例(60%)與1例(6.67%),差異有統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論:1.經(jīng)鼻膽管注入中藥“加減化石利膽湯”對肝外膽管結(jié)石具有碎解、變小甚至完全溶解的作用。2.經(jīng)鼻膽管主要中藥“加減化石利膽湯”可避免部分患者行第2次或反復(fù)的ERCP手術(shù)。
[Abstract]:Objective: to compare and observe the effect of adding and subtracting fossil Lidan decoction into nasobiliary duct after ERCP on the difficulty of operation and the times of operation after EST/EPLBD and so on. Under the condition that the operation time is long and the patients can not remove all the stones due to their poor physical condition, the effect of further litholysis on extrahepatic bile duct giant calculi is obtained. Materials and methods: all the 30 cases were from Shenyang Army. From August 2011 to June 7, 2013, endoscopy and traditional Chinese Medicine Department of District General Hospital were confirmed by ERCP procedure as giant stones of common bile duct and could not be removed at one time during operation. Thirty patients with incarcerated calculi and filled stones were randomly divided into two groups: the experimental group (n = 8), male (n = 8) and female (n = 7), ranging from 53-89 years old, with an average age of 68.25 years. On the first day after operation, 20-50ml was slowly injected into the nasobiliary duct, the end of the nasobiliary duct was closed for 2 hours, twice a day for 30 days, while the control group consisted of 7 males and 8 females aged 46-83 years, with an average age of 67.78 years. The changes of common bile duct diameter and stones during ERCP and ultrasound on day 30 were observed. Results: all patients received traditional Chinese medicine litholysis therapy at the beginning of treatment. Ultrasound and ERCP were performed. The diameter of the common bile duct was 0.69 鹵0.63 cm on the 30th day under ultrasound in the experimental group and 2.84 鹵0.80 cm in the control group (P0.01g), and was found on the second day of ERCP(30. There were 9 cases of complete litholysis in the experimental group and 1 case in the control group. The difference was statistically significant (P 0.01). Conclusion: 1. Infusing the nasal bile duct with the Chinese medicine, "add and subtract Shitao Lidan decoction", has a fragmentation effect on extrahepatic bile duct stones. The effect of diminution or even complete dissolution. The main Chinese medicine, "add and subtract fossil Lidan decoction", can avoid the second or repeated ERCP operation in some patients.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.4

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本文編號(hào)：1655649