| Gallstone is a common disease in digestive system diseases.Foreign researchers have reported that the incidence of gallstone was about10%.Gallbladder stones accounted for 90% in gallstone disease,and the incidence of gallstones combined with common bile duct stones was 12% ~21%.The clinical characteristics is unusually high incidence and repeated episodes.Not only does it harm people's health,but also lets them bear great burden in their hearts.Therefore,the treatment of gallstones combined with common bile duct stones has been concerned by many researchers.Open cholecystectomy,common bile duct exploration and T tube drainage was used as the traditional treatment of gallstones combined with common bile duct stones.The surgical defect is traumatic big,slow recovery and incision infection.With the development of minimally invasive surgical techniques,the new treatment strategies of gallstones combined with common bile duct stones emerge.The first step include Edoscopic sphincterotomyoral and common bile duct stones surgery.The second step include laparoscopic cholecystectomy.As the gallbladder function and Iatrogenic bile duct injury would have been in depth studied,the researchers asked whether it was necessary to have a functional gallbladder removed.As is known to all,Ursodeoxycholic Acid is effective drugs for the treatment of gallbladder stones.So considered above aspects,We would have exploded such a scheme in the treatment of gallstones combined with common bile duct stones.The first step include Edoscopic sphincterotomyoral and common bile duct stones surgery.The second step include oral Ursodeoxycholic Acid in the treatment of gallbladder stones.In order to achieve reliable curative effect and preservation of gallbladder,we would be carrying out the investigation.Objective:In order to provide reliable curative effect and safety treatment plan for patients of gallstones combined with common bile duct stones,we will analyze the clinical effectiveness and safety on EST and ursodeoxycholic acid.It will provide useful references data on individual therapy of gallstones combined with common bile duct stones.Methods:1 Object of study Select Chengde Central Hospital of gallstones combined with common bile duct stones patients in October 2014 to September 2016 period 76 cases.All patients were divided randomly into the UDCA group and bland group,including 36 patients in UDCA group and 40 patients in bland group.During the flow-up period,6 cases(1 in UDCA group,5in bland group)withdrew form the trial.70 cases(35 in UDCA group,35 in bland group)completed experiment.There were no significant differences in age,sex,average body mass index,gallbladder stone size and number between the two groups(Table 1?2?3).2 Therapeutic method(1)UDCA group:According to diagnosis and treatment guideline on endoscopic retrograde cholangiopancreatography accomplished in 2010,endoscopic physicians completed EST and common bile duct stones surgery.All cases received alike anti-inflammation,routine nursing and diet guide.They started receiving oral ursodeoxycholic acid(10mg/Kg/d,1 times a night,the course of 4 months)on the fifteen postoperative day.(2)Bland group: EST and common bile duct stones surgery of the bland group was similarly completed by the same endoscopic physicians.the bland group did not receive special treatment except routine treatment after operation.3 observation target(1)Curative effect observation index: all patients were followed to record gallbladder stones,gallbladder wall thickness and gallbladder shrinkage by the B mode ultrasound.(2)Safety observation index:paying attention to the related symptoms(abdominal pain and fever);reviewing of blood routine and liver function.4 statistical approach SPSS19 statistical software was used for statistics analysis.The results of measurement data were expressed as x ± s.The comparison between the two groups was carried out by using the independent samples.Paired t-test was used in the comparison.The results of the count data was expressed by the rate.Chi-square test was used to the count data.All statistical are two-tailed test,p<0.05 was considered statistically significant.Results:1 Followed up for four months,the UDCA group cure rate was40.00%(14/35),the bland group cure rate was 14.29%(5/35).There was a significant difference in the cure rate between the two groups(p=0.016).The group of UDCA was followed up for two and four months,and the cure rate of its was 11.43%(4/35)and 40%(14/35).There was a significant difference in the cure rate among different time periods in the UDCA group(p=0.006).2 Followed up for four months,the effective rate of UDCA group was74.29%(26/35),the bland group was 28.57%(10/35).There was a significant difference in the effective rate between the two groups(p<0.05).The group of UDCA was followed up for 2 and 4 months,the effective rate of its was22.86%(8/35)and 74.29%(26/35).There was a significant difference in the effective rate among different time periods in the UDCA group(p<0.05).3 Followed up for four months,the gallbladder wall thickness of UDCA group was lower than that before treatment.There was a significant difference between the two groups(t=27.213,p<0.05).The gallbladder wall thickness of the blank group was also lower than that before treatment.There was a significant difference between the two groups(t=22.082,p<0.05).Compared the two groups,the UDCA group was superior to the blank group in gallbladder wall thickness(p=0.005).4 Followed up for four months,the gallbladder contraction rate of UDCA group was higher than that before treatment,the difference was statistically significant(p<0.05),the gallbladder shirinkage of UDCA group also became higher than pre-treatment(p<0.05).Compared the two groups,the UDCA group in gallbladder shrinkage was superior to the blank group(p<0.05),thedifference was statistically significant.5 In the process of follow up and treatment,6 cases emerged common bile duct stones for two groups.The recurrence rate of the UDCA group was2.78%(1/36),and common bile duct stones recurrence rate of the bland group was 12.50%(5/40).6 In the process of follow up and treatment,6 cases(1 in UDCA group,5 in bland group)were accompanied by abdominal pain and(or)fever.7 In the process of follow up and treatment,7 cases(2 in UDCA group,5 in bland group)of blood routine and(or)liver function changed.Conclusion:1 For those with gallbladder stones(d<1.5cm),Ursodeoxycholic Acid could bring about a striking effect based on Endoscopic sphincterotomy.As time passed,the curative effect would be increased.2 On the basis of Endoscopic sphincterotomy,Ursodeoxycholic Acid could significantly increase gallbladder shrinkage and also obviously decreased gallbladder wall thickness.3 On the basis of Endoscopic sphincterotomy,Ursodeoxycholic Acid had no significant harmful influence on common bile duct stones recurrence.4 On the basis of Endoscopic sphincterotomy,when Ursodeoxycholic Acid could bring about abdominal pain in treating gallbladder stones,this could associate with inducing acute cholangitis.5 There were no significant side effects,such as blood routine,liver function in oral Ursodeoxycholic Acid. |
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