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膽管結核
膽管結核治療
(一)陰虛血瘀型
1.臨床表現低熱或午後潮熱,右脅肋或右上腹隱痛,顴赤、盜汗、形瘦、乏力或見右上腹包塊觸痛;可有面黃目黃.舌紅,苔少,脈細澀.
2.輔助檢查見本病之診斷.
3.病機分析
“癆瘵主乎陰虛”,陰虛生內熱,故低熱或潮熱;瘵蟲侵犯膽腑,與淤血凝結為包塊,故右脅或右上腹隱痛或見包塊;膽汁受阻外溢則見黃疸;陰虛陽亢則顴赤;內熱熏蒸,陰津外泄而盜汗;陰精虧耗則形體消瘦而乏力.舌紅,少苔為陰虛有熱之象.脈細澀為陰虛血少之征.
4.治療宜滋陰殺蟲,化瘀散結.
(1)中藥湯劑:膽道結核的治療可選黃精鱉甲湯加減.
方解:黃精、玉竹、何首烏滋陰養血以扶正;金銀花、連翹、夏枯草清熱去邪殺瘵蟲;胡黃連、銀柴胡退虛熱,清疳熱;鱉甲、丹參軟堅散結,活血化瘀.加減:盜汗甚加地骨皮、浮小麥以止汗;納少者加雞內金、山楂以開胃;有黃疸者加虎杖、金錢草以清熱退黃.
亦可選:葎草合劑、清骨散合清營湯、大補陰丸合80l合劑等加減治療.
(2)其他藥物:①白及散,每服3～5g,每日2～3次.②抗癆丸,每次1丸,每日3次.③魚百片,每服4～6片,每日4次.
(3)外敷藥:膽道結核的治療可用消核膏敷於包塊之皮膚處,2～3日換藥1次,10次為1療程.
(4)抗結核藥物:如利福平、異煙肼、乙胺丁醇、吡嗪酰胺、鏈黴素等.為提高療效,減少結核桿菌的抗藥性,宜聯合應用2～3種藥物.或用抗結核的復合制劑.如衛非寧150(利福平與異煙肼)或衛非特(利福平、異煙肼與吡嗪酰胺).服藥期間,每月查肝功1次,若肝功受損應調整用藥.
(5)手術治療:對療效不好之瘺管或膽囊結核可考慮手術治療.
5.轉歸預後本型若能較早明確診斷,一般預後較好.但需長時間用藥才能徹底治愈.
(二)氣陰兩虛型
1.臨床表現少氣懶言,自汗、盜汗,午後潮熱,面白顴紅.舌嫩紅有齒痕,苔薄少,脈細弱.
2.輔助檢查.
3.病機分析本型是在陰虛之基礎上,因久病耗氣而導致氣陰兩虛.盜汗,潮熱,顴紅為陰虛內熱;因有氣虛故又有倦怠乏力,少氣懶言及衛外不固而自汗等癥狀.舌嫩紅有齒痕,苔少,脈弱均為氣陰不足之象.
4.膽道結核的治療治療宜益氣養陰,扶正殺蟲.
(1)中藥湯劑:生脈散合黃精鱉甲湯加減.
方解:人參大補元氣,生津安神;五味子益氣生津,固表斂汗;麥冬養陰生津,三藥合用益氣養陰而斂汗.黃精鱉甲湯之功用見陰虛血瘀型之方解.加減:氣虛較重者可加黃芪、白術以助人參補氣之力.納呆食少者可去鱉甲,加雞內金、山楂、麥芽以醒脾開胃.亦可選生脈散合80l合劑,生脈散合葎草合劑等加減治療.若久病不愈,又出現畏寒、肢冷、浮腫等癥狀則為陰陽兩虛.膽道結核的治療可在益氣養陰之基礎上酌加冬蟲夏草、紫河車、補骨脂、鹿角膠等溫補扶正之品.
(2)中成藥、外敷藥、抗結核藥、手術治療等,參見陰虛血瘀型.
膽管結核飲食
https://jbk.jiankang.com/jibing/8796/%3Cp%20>1,木耳百合湯:https://jbk.jiankang.com/jibing/8796/%3Cp%20>https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]白木耳20 g,百合30 g.冰糖適量.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]先將白木耳用清水泡發並去蒂,與百合一同放入沙鍋中煎熬,待熟時放入冰糖即可.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]養陰、清虛熱.適用於陰虛潮熱者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]1劑/d,分早、晚2次服用.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>2,紅柳元魚排骨湯:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]元魚1隻(約重400 g),知母、地骨皮各6 g,水發香菇、冬筍各20 g,排骨100 g,調料適量.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將知母和地骨皮水煎2次,合並藥液,濃縮至12 g,元魚殺後去殼及內臟,洗幹凈,開水氽一下,撈出,刮去外膜洗幹凈,切成8～10塊,沙鍋中放入洗幹凈的排骨、蔥、薑、元魚,添清湯1 500 g及藥液,上屜蒸酥爛,將元魚置盤中,潷出清湯加味精、料酒、胡椒粉、精鹽,詞好口味,倒入沙鍋中,煮沸片刻即可.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]滋陰清熱.適用於骨蒸潮熱,長期低熱不退,潮熱盜汗而屬陰血虧虛者.用於泌尿生殖系結核和各種結核久治不愈者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]1劑/d.分早、中、晚佐餐服食.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>3,鱉甲柴胡湯:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]鱉甲15 g,黨參10g,銀柴胡、百部各9 g,蜂蜜適量.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將鱉甲炙後,研成粉末}把其他幾味藥加水,用沙鍋煎熬成湯液,然後將鱉甲粉末放入藥液中,調入蜂蜜即可.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]滋陰清火.適用於陰虛火旺的骨蒸潮熱的結核病患者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]1劑/d,分早、晚服用,連服數日.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>4,豬肺天冬湯:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]天冬50 g,知母30 g,黃芪15 g,地骨皮20 g,紅棗5枚,豬肺300 g.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將豬肺清洗幹凈,焯水,去掉腥味,切成小塊;把其他藥物放入沙鍋中,加水適量煎熬成湯液,去渣後放入豬肺,再加一定的清水煎煮,煎煮至豬肺熟爛為度.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]滋陰潛陽.適用於各種氣虛不固的結核病恢復期患者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]2次/周.佐餐服食.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>5,浮小麥大棗湯:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]浮小麥30 g,大棗8枚,甘草5 g,蜂蜜適量.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將前3味藥煎熬成湯液,去渣後加入蜂蜜即可.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]清熱除煩.適用於結核病盜汗、自汗患者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]1劑/d,連服半個月.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>6,百合天門冬粥:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]百合、天冬(天門冬)各30 g,粳米100 g,冰糖適量.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將百合與天冬放入沙鍋中,加入清水約500 mL,去渣後留汁,把粳米淘洗幹凈,加入藥液煎熬成稀粥,待溫時放入冰糖.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]滋陰清虛熱.適用於陰虛發熱的結核病患者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]1劑/d,分2次服用.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>7,糯米蒜粥:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]紫皮大蒜30 g,糯米50 g,白糖適量.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將紫皮大蒜去皮,放入沸水中煮1～2分鐘後撈出;將糯米淘洗幹凈,放入沙鍋中,加清水適量煎熬成粥,把蒜放入其中,再煎熬片刻即可.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]清熱祛癆.適用於各種結核性疾病患者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]1次/d,連服數周.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>8,薏苡仁豬肺粥:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]薏苡仁50 g,豬肺1具(約重300 g).https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將豬肺洗幹凈,焯水去泡沫,切成小塊,放入沙鍋中,加清水適量煮成爛熟;把薏苡仁研成細末,放入煮熟的豬肺湯中即可.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]清熱補陰.適用於骨蒸潮熱,盜汗患者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]1次/d,連服1周.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>9,蛤蜊韭菜肴:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]蛤蜊50 g,韭菜(韭菜芽更好)30 g.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將蛤蜊肉洗幹凈切細,韭菜洗澡幹凈切成段,一同放入炒鍋中,用小火炒熟即可.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]清熱補陰.適用於結核陰虛盜汗患者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]1次/d,作菜肴食用.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>10,準山蓮子粉:https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[原料]山藥(淮山)250 g,蓮子150 g,芡實120 g.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[制法]將3味藥略洗一下,曬幹,研成細末,裝入膠囊中(3～5 g/粒).https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[功效]滋陰補虛.適用於各種結核病體虛患者.https://jbk.jiankang.com/jibing/8796/%3Cp%20>
https://jbk.jiankang.com/jibing/8796/%3Cp%20>[服法]3～5丸/次,3次/d.
膽管結核並發癥
單純的膽管結核很少,多與肝結核或腸結核伴發.各年齡組均有,但以青年人為多.在上述結核病的治療過程中,膽管結核亦獲得治療,故內科學、肝膽病學多不做為獨立的疾病論述:但有時患者也可能以膽管的癥狀而就診.如膽囊結核患者可能以右上腹腫塊為主述,膽管結核患者可能以黃疸為主述而就診,因而也應當有所重視.
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