胆石排出的条件及其影响因素

近年来,全国各地普遍开展中西医结合非手术排石疗法治疗胆石病,临床经验愈来愈多,临床疗效亦有了新的提高。然而,也有一些例外,尽管甲单位与乙单位的排石方法相近,方药组成相同,胆石病的诊断可靠,从大便淘洗结石也很认真,而排石疗效却相差悬殊。要全面解释其原因似较困难。据我院1974～1981年开展中西医结合治疗胆石病的临床体会,不研究胆石排出的条件及其影响因素,至少不能获得排石良效。本文试就这一问题浅谈看法,供同道参考。

英文摘要:

The choleith-expelling therapy by means of TCM-WM is a non-operative therapy on the basis of the function of the body. If the function is ignored or if we do not pay attention to unfavourable factors and conditions in expelling cholelith,the therapy cannot bring about the expected result.From the author’s practice,three basic conditions to help expel the stones have been suggested:1.The patient’s health condition,that is,the function of various organs is not wehkened.2.There exists cholelithic obstruction in the bile duct.3.No fibrotic stricture is found in the bile duct.The third condition seems the most important,but its diagnosis is difficult.Through several years’ experience,our diagnostic procedures are as follows:1.The patient has a long medical history of cholelithiasis with a high jaundice incidence which fades slowly or even stays.2.In some cases,ifthe sign of stone-expelling occurs twice after the treatment but no stones are expelled,then there will be a very slow remission or situation will be even getting worse gradually.3.The choledochogram shows that the developer is discharged slowly in the choledocus (the developer is still there or even dense 120 minutes after the injection in hepatic and bile ducts).The lower end of the choledocus presents a funnel-shape or a form like the tail of a mouse.Based on the above-mentioned synthetic diagnosis an accuracy of 80% has been achieved. Following factors are unfavourable to the expelling of cholelith and demand our attention:1.There is serious inflammation in the bile duct.2.Relaxant is used too early when there is an attack of cholecystalgia.3.The expelling process is not well timed.4.No effective treatment is taken.5.Complications are found 6.Turnout is found concomitantly in the liver, gallbladder and pancreas or there is congenital malformation of the cholic system.7.The cholelith is too large,spongy or adhesive to the wall of the bile duct,etc.

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