| Objective Observation of postoperative patients with extrahepatic bile duct calculi patients with postoperative 12 flavour liver cholagogue granules on blood routine,liver function,bile and postoperative T tube drain out the influence of the time,and through comparing two groups of patients discharged patients follow-up recurrence of extrahepatic bile duct stones,and on the basis of the analysis of cause of postoperative patients with extrahepatic bile duct calculi recurrence of independent risk factors,and to assess the twelve flavour liver cholagogue particles can effectively reduce the risk indexes in order to achieve long-term clinical curative effect of prevention and treatment of extrahepatic bile duct stone recurrenceMethods(1)Retrospective analysis was performed on the data of 237 cases of choledocholithiasis confirmed as extrahepatic bile duct stones admitted to the First Affiliated Hospital of Anhui University of Chinese Medicine from September 2015 to September 2020.Patients were divided into control group and observation group according to the application of Twelve Shugan Lidan Granules.(2)Surgical treatment was performed in both groups: traditional open surgery,laparoscopic lithotomy and T tube placement.Observation group was given 12 Shugan Lidan Granules orally on the second day after surgery,1 packet/time,3 times a day,on the basis of conventional postoperative hemostasis,anti-infection,liver protection and other treatments.The control group only received routine treatment after operation.(3)The changes of blood routine and liver function indexes before and on the 1d,3d,7d and 14 d after operation were observed in the two groups.The changes of biliary drainage volume in T tube 1d,3d,5d and 7d afer surgery were observed and recorded,and the final T tube extraction time was recorded.All patients were followed up for 24 months,and were ordered to go to the outpatient department of our hospital for color Doppler ultrasound and MRCP examination(once a month 3 months after surgery,once every 6 months thereafter),and the recurrence of calculi in the two groups were compared.(4)Data were collected and SPSS 21.0 was used for statistical analysis.Measurement data conforming to normal distribution were represented asx±s;The rank sum test was used to test if the normal distribution was not met.The t-test was used to compare the mean between the two groups.Enumeration data are presented in frequency or rate;x2test was used to compare the rates.Logic regression analysis was used to assess risk factors,and the results were expressed as OR and 95% confidence intervals(CI).P<0.05 indicates that the difference is statistically significant.Results(1)There were no significant differences between the two groups in gender,age,operation method,operation frequency,stone size,number and common bile duct diameter;(P> 0.05);(2)Before treatment,there were no significant differences in WBC and NEU count levels between 2 groups(P > 0.05).After treatment,7d,14 d WBC and NEU count in the observation group were lower than those before treatment.(compared with before treatment,P <0.05);(3)Before treatment,there were no significant differences in ALT,AST,ALB,PA,DBIL and IBIL levels between the two groups(P > 0.05).After treatment,ALT,AST,DBIL and IBIL levels were significantly decreased,PA was significantly increased,and ALB had no significant difference between the two groups on the 7th and 14 th day after operation.The levels of ALT,AST,DBIL and IBIL in the observation group were lower than those in the control group and higher than those in the control group at 7 and 14 days after surgery(P < 0.05),and the difference was statistically significant.There was no significant change in ALB.(4)After treatment,1d and 3d after surgery,there was no significant difference in biliary drainage volume between the two groups(P > 0.05),on the 5th and 7th day after surgery, the bile drainage volume in the observation group was higher than that in the control group,and the difference was statistically significant(P < 0.05);The extubation time of the observation group was shorter than that of the control group in terms of the final T-tube extraction time,and the difference was statistically significant(P < 0.05)(5)Follow-up results: A total of 237 people were followed up in the two groups,of which 106 were actually followed up.The longest follow-up time was 24 months,the shortest was 12 months,and the average follow-up time was 18 months.In the control group,16 patients(14.68%)had recurrence.The shortest recurrence time was 2 months,the longest recurrence time was 18 months,and the tie recurrence time was 10.5months.In the observation group,10 patients(7.81%)had recurrence.The shortest recurrence time was 6 months,the longest recurrence time was 18 months,and the tie recurrence time was 13.5 months.The difference in the recurrence rate of calculi between the two groups was statistically significant(x2 =7.633,P=0.021).In the same group,the recurrence rate of calculi was significantly reduced by laparoscopic surgery compared with open surgery,and the difference was statistically significant(x2=6.008,P=0.032);(x2 =11.231,P=0.019),there was no significant difference in the recurrence rate of stones between the observation group and the control group(P >0.05).There was significant difference in the recurrence rate of stones between patients undergoing multiple operations and those undergoing one operation,and the difference was statistically significant(x2 =9.806,P=0.021);(x2 = 13.855,P=0.003).There was no significant difference in stone recurrence rate between patients with abnormally elevated neutrophils and patients with abnormally elevated leucocytes(x2=2.086,P=0.420);(x2 =1.335,P=0.821).Compared with the control group,the recurrence rate of stones in patients with preoperative abnormal WBC and NEU was significantly different(P < 0.05).The recurrence rates of patients with abnormal ALT,AST,ALB,PA,DBIL and IBIL before surgery in observation group were significantly different from those in control group(P < 0.05).Logic regression model adjusted the number of operations,the number of abnormal preoperative inflammatory indicators, and the number of abnormal preoperative liver function,and the results showed that:history of multiple biliary operations[OR=2.31(95%CI: 1.34-3.97),P < 0.01],abnormal preoperative WBC [OR=1.58(95%CI: 0.81-3.10),P<0.01],abnormal preoperative NEU[OR=3.60(95%CI: 1.90-6.82),P < 0.01],abnormal preoperative ALT[OR=3.48(95%CI: 1.90-6.82)],abnormal preoperative ALT[OR=3.48(95%CI:1.86-6.40),P < 0.01],abnormal AST before operation[OR=3.86(95%CI: 2.23-4.32),P < 0.01],abnormal ALB before operation[OR=3.92(95%CI: 2.41-4.58),P < 0.01],abnormal PA before operation[OR=4.01(95%CI: 2.56-5.01),P < 0.01],abnormal DBIL before operation[OR=3.98(95%CI: 2.56-5.01),P < 0.01],abnormal preoperative IBIL [OR=3.96(95%CI:2.42-4.60),P < 0.01] were independent risk factors for postoperative biliary stone recurrence.Conclusion Postoperative twelve flavour liver cholagogue particles can effectively control the infection of biliary tract and bile duct inflammation,blocking the formation of bile stone sex,quickly improve liver function,promote patients adjust the secretion and metabolism of liver function,and then reverse the bile duct calculi recurrence lithotomy,reduce pressure in the bile duct,reduce cholestasis,promote residual stone out,reduce the patients with tube time,significantly reduced in patients with long-term extrahepatic bile duct calculi recurrence rate,both to reduce the patient’s physical and mental burden,also increase the efficiency of medical resources,brought good social benefits and economic benefits,is worth popularizing in daily clinical practice. |
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