| Objective: Laparoscopic cholecystectomy combined with ERCP is effective in the treatment of cholecystolithiasis with choledocholithiasis.It is possible to remove the gallbladder and common bile duct stones in a single operation.However,due to EST and EPBD during the operation of ERCP,the function of papillary sphincter was partially damaged,and duodenal fluid was easy to flow back into the common bile duct.There is still a high recurrence rate of stone after LC combined with ERCP.The recurrence of choledocholithiasis seriously affects the life of patients and increases the economic burden of patients,and some patients even threaten their lives due to acute cholangitis.However,for preventing the recurrence of choledocholithiasis after LC combined with ERCP,domestic and foreign studies have not found any drugs with significant clinical effect.This study was conducted from the perspective of microbial flora through experimental research to explore the influence of Chinese medicine Qingre Lidan Granules on the biliary microflora of patients after LC combined with ERCP lithotomy,so as to explore the preventive effect of Qingre Lidan Granules on recurrent choledocholithiasis.Methods: In this experimental study,bile was collected from patients diagnosed with cholecystolithiasis combined with choledocholithiasis who underwent LC combined with ERCP lithotomy/and ENBD drainage catheter indenture at the First Affiliated Hospital of Dalian Medical University from January 1,2022 to December 31,2022 on day 1 and day 4 after surgery.After inclusion and exclusion criteria screening,patients were divided into medication group(conventional Western medicine treatment + Qingre Lidan granules group)and control group(conventional western medicine treatment group)according to whether they took Qingre Lidan granules after surgery.The composition of biliary microflora in the two groups was analyzed by 16 s r DNA amplification sequencing method on the 1st and 4th day after surgery.The changes of biliary microflora in the treated group and the control group were compared to analyze the effect of Qingre Lidan Granules on the biliary microflora in the patients after LC combined with ERCP.Results: A total of 28 patients met the inclusion and exclusion criteria,including 15 patients in the medication group and 13 patients in the control group.The mean age of patients in the medication group(64.8±4.1)was older than that in the control group(62.6±5.6).There were no significant differences in gender,past medical history and other data between the two groups(P > 0.05).In addition,the average values of WBC,NEU and,AST,ALP,gamma-GT on admission were not statistically different between the two groups(P > 0.05).Proteobacteria and firmicuria were dominant bacteria in all bile samples.After the intervention of Qingrelidan Granules,the difference analysis between groups showed that Proteobacteria abundance increased in bile of patients in the medication group.The mean value of bile OTU on the first day after surgery was 25.80±9.03 in the medication group and 26.53±8.98 in the control group.The mean value of bile OTU was 61.00±10.54 in the treatment group and 51.31±11.03 in the control group on the 4th day after surgery.There was no significant difference in the amount of bile OTU between the two groups on day 1 after surgery(25.80±9.03 and 26.53±8.98),but the amount of bile OTU in the medication group was significantly higher than that in the control group(61.00±10.54 and 51.31±11.03).The bile Simpson index was 0.25±0.69 in the treatment group and 0.25±0.72 in the control group on the first day after surgery.The bile Simpson index was 0.55±0.11 in the treatment group and 0.45±0.10 in the control group on the 4th day after surgery.There was no significant difference in Simpson index between the two groups on day 1 after surgery,but the Simpson index of bile in the medication group was significantly higher than that in the control group on day 4 after surgery,indicating that some kinds of bile in the control group were more advantageous than others on day 4 after surgery compared with the medication group.Conclusions: 1.Proteobacteria and firmicuria were dominant bacteria in all bile samples.After the intervention of Qingrelidan Granules,the difference analysis between groups showed that Proteobacteria abundance increased in bile of patients in the medication group.2.Comparing the number of bile OTU between the two groups on day 1 and day 4 after surgery,the increase of bile OTU number in the medication group was significantly more than that in the control group,indicating that Qingrelidan granules could up-regulate the OTU number of bile microflora and increase the abundance ofmicroflora.3.Comparing the bile Simpson index between the two groups on the 1st and 4th day after surgery,the up-regulation of the Simpson index in the bile of the patients in the medication group was significantly higher than that of the control group,indicating that Qingrelidan granules could up-regulate the Simpson index of the bile microflora,increase the uniformity of the bile microflora,and inhibit some more advantageous strains.4.The Shannon index of bile between the two groups on day 1 and day 4 after surgery was compared.The Shannon index of bile in the treated group was significantly higher than that in the control group on day 4 after surgery(P < 0.05),indicating that Qingrelidan granules could increase the diversity of biliary microflora species and regulate the biliary microflora. |
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