目的 探讨疏肝法联合手术治疗肝胆管结石的临床疗效。方法 将67例胆总管结石患者随机分为对照组（32例）和观察组（35例），对照组患者行腹腔镜胆总管探查术治疗，观察组患者在对照组治疗的基础上术后口服加减柴胡疏肝散。干预1周后，观察两组患者机体功能恢复情况和炎症指标、肝功能水平，随访12个月后观察结石复发率。结果 与对照组比较，观察组患者肛门排气时间、进食时间、术后住院时间均明显缩短（P＜0.05）；与治疗前比较，两组患者术后7 d血清超敏C-反应蛋白（high-sensitive C-reaction protein， hs-CRP）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天冬氨酸氨基转移酶（aspartate aminotransferase，AST）、谷氨酰基转移酶（gamma glutamyltransferase，GGT）、碱性磷酸酶（alkaline phosphatase，ALP）水平均明显降低（P＜0.05），观察组患者血清hs-CRP、AST、GGT降低程度显著大于对照组（P＜0.05）；观察组结石复发率显著低于对照组（χ2=6.118，P=0.013）。结论 术后应用疏肝中药能够促进机体胃肠功能恢复，缩短住院时间，降低炎症指标，改善肝功能及降低结石再生和复发率。
Objective To investigate the clinical effect of the liver-soothing method combined with surgery in the treatment of hepatolithiasis. Methods A total of 67 patients with hepatolithiasis were randomly divided into control group with 32 patients and observation group with 35 patients. The patients in the control group underwent laparoscopic common bile duct exploration and cholecystolithotomy, and those in the observation group received oral administration of modified Chaihu Shugan Powder in addition to the treatment in the control group. Body function recovery, inflammation indices, and liver function were observed after 1 week of intervention, and the recurrence rate of calculi was determined after 12 months of follow-up. Results Compared with the control group, the observation group had significantly shorter time to first flatus, time to diet, and length of postoperative hospital stay (P<0.05). On day 7 after surgery, both groups had significant reductions in the serum levels of high-sensitive C-reaction protein (hs-CRP), alanine aminotransferase, aspartate aminotransferase (AST), gamma glutamyltransferase (GGT), and alkaline phosphatase (P<0.05), and compared with the control group, the observation group had significantly greater reductions in hs-CRP, AST, and GGT (P<0.05). The observation group had a significantly lower recurrence rate of calculi than the control group (χ2=6.118, P=0.013). Conclusion Postoperative application of liver-soothing traditional Chinese medicine can promote the recovery of gastrointestinal function, shorten the length of hospital stay, reduce inflammation indices, improve liver function parameters, and reduce stone regeneration and recurrence rate.
张 歆,张 磊,刘 杰,黄 龙,张 琦.柴胡疏肝散加减联合手术治疗肝胆管结石35例临床观察[J].安徽中医药大学学报,2020,39(1):25-28复制