胆宁片预防内镜保胆取石术后胆囊结石复发的研究

Study on Danning tablets in prevention of gallstone recurrence after choledochoscopic gallbladder-preserving cholecystolithotomy

摘要:

目的 探讨中成药胆宁片在内镜保胆取石术（CGPC）后预防胆囊结石复发的作用，及其与牛磺熊去氧胆酸（TUDCA）的差异。方法 纳入2016年11月－2020年1月在北京大学首钢医院符合条件的CGPC后患者1 868例，按取出结石的类型分为两个队列，A队列为取出胆固醇为主的结石，B队列为取出胆色素为主的结石，将每个队列中的患者随机分为两组，DN组口服胆宁片（1.8 g/次，3次/d），TU组口服TUDCA（500 mg/次，1次/d），疗程为180 d，随访时间为36个月，记录胆囊结石复发及胆囊壁厚度的变化情况。结果 两种药物相互比较，在A队列，A-DN组与A-TU组的胆囊结石复发率无明显差异；在B队列，B-DN组的胆囊结石复发率明显低于B-TU组。在两个队列中，DN组术后半年的平均胆囊壁厚度均明显薄于TU组。结论 CGPC后应用胆宁片有助于缓解术后胆囊炎症，能够有效地降低胆囊结石复发率，在预防胆色素为主的胆囊结石复发方面优于TUDCA。

Abstract:

Objective To investigate the effectiveness of Danning tablets in prevention of gallstone recurrence after choledochoscopic gallbladder-preserving cholecystolithotomy (CGPC), and the difference between Danning tablets and tauroursodeoxycholic acid (TUDCA).Methods From November 2016 to January 2020, 1,868 patients were studied following CGPC. Patients were divided into two cohorts according to the type of gallstones. Patients in cohort A had cholesterol stone removal via CGPC, compared to cohort B with bile pigment stone removal by the same treatment. Patients in each cohort were randomly divided into two groups, namely DN and TU. Group DN were prescirbed Danning tablets (1.8 g/time, 3 times/d), while group TU took TUDCA (500 mg/time, once a day). Both groups received treatment for 180 days and were followed up for 36 months. The frequency of recurrence of gallstones and the thickness of the gallbladder wall were recorded.Results By comparing the effects of Danning tablets and TUCDA, the findings indicate that in cohort A, there was no significant difference in the rate of gallstone recurrence between group A-DN and group A-TU. In cohort B, the rate of gallstone recurrence in group B-DN was significantly lower than in group B-TU. In both cohorts, meanwhile, the average thickness of the gallbladder walls was significantly thinner in the two DN groups than in the TU groups half a year after CGPC.Conclusion The results show that prescribing Danning tablets after CGPC can help relieve postoperative gallbladder inflammation and effectively reduce the recurrence rate of gallstones. For gallstones dominated by bile pigments, Danning Tablet is more effective than TUDCA in preventing the recurrence of gallstones after CGPC.