Sackmann M, Pauletzki J, Delius M, Holl J, Neubrand M, Sauerbruch T, Paumgartner G
Department of Medicine II, Klinikum Grosshadern, University of Munich, Germany.
Gastroenterology. 1992 Mar;102(3):988-93. doi: 10.1016/0016-5085(92)90187-4.
Safety and efficacy of shock-wave lithotripsy and bile acid dissolution therapy of patients with gallbladder calculi with a radiopaque rim were evaluated. Eighty-six patients with symptomatic solitary stones were treated by this noninvasive therapy and were followed up to 18 months. Three different lithotripsy treatment modalities were used. Up to 1600 shock wave discharges were applied. Patients in group A (n = 20) were treated with an electrohydraulic water-bath lithotripter at a discharge voltage of 18 +/- 1 kV (mean +/- SD), group B patients (n = 25) were treated with an electrohydraulic water-cushion lithotripter at 19 +/- 2 kV, and group C patients were treated (n = 41) with the same lithotripter at 22 +/- 2 kV. Five to eight months after lithotripsy, 15% in group A were free of fragments compared with only 4% in group B (NS vs. group A), and 38% in group C had no stones (NS vs. group A; P = 0.007 vs. B). Thirteen to eighteen months after lithotripsy, the respective results were 59% in group A, 37% in group B (NS vs. group A), and 68% in group C (NS vs. group A; P = 0.05 vs. group B). Patients with fragments of less than or equal to 3 mm in diameter showed significantly better fragment clearance than those with larger fragments. The frequency of adverse effects was not significantly different between the three groups. Biliary colic occurred in 43% of the patients and mild biliary pancreatitis in 3 patients. Endoscopic sphincterotomy was required in 1 patient, and elective cholecystectomy was performed in 6 patients. Using a water-cushion lithotripter at high-power setting, selected patients with solitary gallbladder stones with a radiopaque rim may be treated safely and successfully by shock-wave lithotripsy combined with bile acid dissolution therapy.
对具有不透射线边缘的胆囊结石患者进行冲击波碎石术和胆汁酸溶解疗法的安全性和有效性进行了评估。86例有症状的单发结石患者接受了这种非侵入性治疗，并随访了18个月。采用了三种不同的碎石治疗方式。施加了高达1600次冲击波放电。A组（n = 20）患者使用电动液压水浴碎石机，放电电压为18±1 kV（均值±标准差），B组患者（n = 25）使用电动液压水垫碎石机，电压为19±2 kV，C组患者（n = 41）使用同一碎石机，电压为22±2 kV。碎石术后5至8个月，A组15%的患者无结石碎片，而B组仅为4%（与A组无显著差异），C组38%的患者无结石（与A组无显著差异；与B组相比P = 0.007）。碎石术后13至18个月，相应结果为A组59%，B组37%（与A组无显著差异），C组68%（与A组无显著差异；与B组相比P = 0.05）。直径小于或等于3 mm的结石碎片患者的结石碎片清除情况明显优于结石碎片较大的患者。三组之间不良反应的发生率无显著差异。43%的患者出现胆绞痛，3例患者发生轻度胆源性胰腺炎。1例患者需要进行内镜下括约肌切开术，6例患者接受了择期胆囊切除术。使用高功率设置的水垫碎石机，对于选定的具有不透射线边缘的单发胆囊结石患者，冲击波碎石术联合胆汁酸溶解疗法可以安全、成功地进行治疗。
