牛磺熊去氧胆酸与熊去氧胆酸对预防保胆术后结石复发的临床研究

摘要

Objective To evaluate the clinical effect between tauroursodeoxycholic acid ( TUDCA) and ursodeoxycholic acid ( UDCA) on preventing the relapse of cholelithiasis after gallbladder-preserving lithotomy via choledochoscope . Methods A total of 313 patients of cholecystolithiasis in Peking University Shougang Hospital undergoing gallbladder -preserving lithotomy via choledochoscope were divided into TUDCA and UDCA group by odd and even numbers of their medical record .The TUDCA group took 500 mg TUDCA (commodity name: Taurolite, Bruschettini S.r.l., Italy, import approval number: H20070200/H20110233) once per night, for 5 days consecutively, and withdrew the drug for 10 days, 15 days was considered a cycle;the UDCA group took 500 mg UDCA ( commodity name:Ursofalk, Dr.Falk Pharma GmbH, German, import approval number: H20050181) once per night .The total course of treatment of the two groups was 180 d.Nursing and diet therapies were the same in the two groups .The cases were checked at regular intervals after surgery with B ultrasonography and were followed up .The recurrence rate of calculi , the change of the thickness of gallbladder wall and the rate of gallbladder contraction were recorded . Results The two groups were followed up for 12-30 months.The 2-year recurrence rates of cholecystolithiasis were 3.7% and 12.4% respectively in the two groups ( log-rankχ2 =5.304, P =0.021 ). Conclusion The effect of TUDCA is better than that of UDCA in preventing the relapse of cholecystolithiasis for patients with gallbladder-preserving lithotomy via choledochoscope .%目的：评价牛磺熊去氧胆酸（ TUDCA）与熊去氧胆酸（ UDCA）对保胆取石术后患者预防胆囊结石复发的差异性及其临床价值。方法2010年10月～2011年12月，我院内镜微创保胆手术成功的313例胆囊结石按病历号奇偶分为TUDCA组（n＝161）和UDCA组（n＝152），术后2周TUDCA组口服牛磺熊去氧胆酸胶囊（商品名：滔罗特，意大利贝斯迪大药厂生产，进口批文号：H20070200、H20110233）500 mg，每晚1次，连续服用5天后，停药10天，15天为一周期；UDCA组口服熊去氧胆酸胶囊（商品名：优思弗，德国Dr．Falk药厂生产，进口批文号H20050181）500 mg，每晚1次。两组服药疗程均为180天。两组术后护理、饮食等均相同。术后定期随访及复查B超，观察记录胆囊结石复发、胆囊壁厚度变化以及胆囊收缩率。结果2组随访时间12～30个月，TUDCA组和UDCA组2年胆囊结石复发率分别为3．7％和12．4％（log-rank χ2＝5．304，P＝0．021）。结论内镜微创保胆取石术后口服TUDCA预防胆囊结石的复发效果优于UDCA。