不同中医证型胆总管结石患者经内镜逆行胰胆管造影术围手术期临床特征的相关性分析OA

Objective To investigate the differences and correlations in perioperative clinical characteristics among patients with different traditional Chinese medicine(TCM)syndrome types of choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods Clinical data of 172 patients with choledocholithiasis who underwent ERCP at Foshan Hospital of Traditional Chinese Medicine from January 2021 to April 2025 were retrospectively analyzed.According to the Expert Consensus on the Diagnosis and Treatment of Cholelithiasis with Integrated Traditional Chinese and Western Medicine(2025),patients were classified into four TCM syndrome types:damp-heat in the liver and gallbladder syndrome,insufficienty of liver yin syndrome,liver depression and qi stagnation syndrome,and blood stasis obstruction and stagnation syndrome.Differences in preoperative and 24-hour postoperative blood routine parameters[white blood cell count(WBC),neutrophil count(NEUT),eosinophil count(EOS),platelet count(PLT)],liver function parameters[alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(GGT),alkaline phosphatase(ALP),total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB)],and the tumor marker carbohydrate antigen 19-9(CA199)were compared among the four syndrome types.Results(1)Distribution of TCM syndrome types and general data:damp-heat in the liver and gallbladder syndrome was the most prevalent syndrome type[63.37%(110/172)],followed by blood stasis obstruction and stagnation syndrome[12.79%(22/172)],liver depression and qi stagnation syndrome[12.21%(21/172)],and insufficienty of liver yin syndrome[11.05%(19/172)].Patients with blood stasis had the highest mean age(69.00±7.95)years and a significantly higher proportion of concomitant cholecystitis[36.36%(8/22)]compared to other syndrome types.(2)Preoperative indicators:WBC and NEUT levels were significantly higher in the blood stasis obstruction and stagnation syndrome compared to the other three types(P＜0.05),with a ranking of blood stasis obstruction and stagnation syndrome＞damp-heat in the liver and gallbladder syndrome＞liver depression and qi stagnation syndrome＞insufficienty of liver yin syndrome.ALB levels were significantly lower in the blood stasis syndrome than in the other types(P＜0.05).(3)Postoperative indicators:In the damp-heat in the liver and gallbladder syndrome and blood stasis obstruction and stagnation syndrome,postoperative levels of ALT,AST,GGT,TBIL,and DBIL were significantly improved compared to preoperative levels(P＜0.05 or P＜0.01 or P＜0.001);in the liver depression and qi stagnation syndrome syndrome,postoperative ALT,AST,and GGT levels were also significantly improved.Liver function recovery was relatively slow in the insufficienty of liver yin syndrome,no significant improvements were observed in all indicators except AST(P＞0.05).In the blood stasis obstruction and stagnation syndrome,postoperative WBC and NEUT levels were significantly decreased compared to preoperative levels(P＜0.001).Conclusion Damp-heat in the liver and gallbladder syndrome is the predominant TCM syndrome type in patients with choledocholithiasis.Significant differences exist in perioperative clinical characteristics among patients with different TCM syndrome types undergoing ERCP.Integrating TCM syndrome differentiation with laboratory indicators may optimize perioperative management.