药物预防经内镜逆行胰胆管造影术后结石复发的疗效观察

Curative effect of drugs on the prevention of bile duct stones recurrence after ERCP

摘要:

评价牛磺熊去氧胆酸（TUDCA）及胆宁片（DN）在经内镜逆行胰胆管造影术（ERCP）取石治疗后预防胆总管结石复发中的临床应用价值。方法 210例经ERCP治疗的胆总管结石患者，术后采用完全随机化分组法分为3组。对照组不服药，TUDCA组口服TUDCA，DN组口服DN。术后药物治疗并随访24个月定期复查胆道超声及磁共振胰胆管成像（MRCP）。比较3组患者胆总管结石复发率、胆固醇饱和度指数（CSI）、血脂水平。结果 190例患者完成治疗及随访。①术后24个月内对照组、TUDCA组、DN组结石复发率为17.46%（11/63）、6.34%（4/63）、10.94%（7/64）；TUDCA组、DN组复发率均明显低于对照组（P <0.05），TUDCA组复发率明显低于DN组（P <0.05）；②术后第10天，TUDCA组CSI值明显低于对照组、DN组（P <0.05）；DN组与对照组差异无统计学意义（P >0.05）；③结石未复发患者中，TUDCA组患者的总胆固醇（TC）、低密度脂蛋白（LDL）明显低于对照组、DN组（P <0.05）；而TUDCA组高密度脂蛋白（HDL）明显高于对照组、DN组（P <0.05），DN组HDL含量与对照组比较差异无统计学意义（P >0.05）。结论 胆总管结石患者ERCP治疗后口服TUDCA及DN均能有效降低结石复发率，且TUDCA效果更优于DN。

Abstract:

To evaluate the curative value of the tauroursodeoxycholic acid (TUDCA) and Danning table (DN) in the prevention of bile duct stones recurrence after ERCP. Methods 210 patients with Choledocholithiasisby ERCP were randomly divided into 3 groups. The patients in the control group were not given any medicine. The patients in the TUDCA group took TUDCA every night. The patients in the DN group took Danning tablets of three times a day. The course of medication and followed up for the patients was 24 months after the operation. All the patients would be examined regularly by Biliary color doppler ultrasound and MRCP. The recurrence rates of Choledocholithiasis, cholesterol saturation index and serum lipid were recorded and compared statistically between the three groups. Results In total, 190 patients completed the treatment and follow-up according to the experimental design. The recurrence rates of the control, TUDCA and DN group were 17.46% (11/63), 6.34% (4/63) and 10.94% (7/64). The recurrence rates in the TUDCA and DN group were significantly lower than those the control group (P < 0.05).The recurrence rate in the TUDCA group was significantly lower than that in the DN group; On the tenth days after the operation, the CSI in the TUDCA were significantly lower than those the control group and the DN group (P < 0.05). There was no statistically significant difference between the DN group and the control group (P > 0.05); To the patients without recurrence, the level of TC, LDL in the TUDCA group were significantly lower than those the control group and and the DN group (P < 0.05). The level of HDL in the TUDCA group were significantly higher than those the control group and and the DN group (P < 0.05). There was no statistically significant difference on the level of HDL between the DN groupand the control group (P > 0.05). Conclusion The application of TUDCA and DN for patients with Choledocholithiasis after ERCP can effectively reduce the recurrence rates, the curative effect of TUDCA more than DN.