Sauerbruch T, Holl J, Sackmann M, Paumgartner G
Medical Department II, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Germany.
Hepatology. 1992 Feb;15(2):208-14. doi: 10.1002/hep.1840150207.
Over 5 yr, 103 elderly patients (mean age = 70 yr) with bile duct stones (mainly not amenable to endoscopic extraction) underwent adjuvant extracorporeal shock-wave lithotripsy using a first-generation kidney lithotripter. Disintegration of stones was achieved after a mean of 1.4 sessions in 92% of the patients. Spontaneous passage of fragments into the duodenum occurred in one fourth of the patients, and endoscopic extraction of fragments was necessary in 75% of the patients, resulting in complete clearance of the bile duct stones in 91 (88%) of 103 patients. The most important adverse effect was septic disease after extracorporeal shock-wave lithotripsy in 4% of the patients. The 30-day mortality rate was 1% (one patient), and another 15 patients died during a mean follow-up of 26 +/- 14 mo (mainly of causes unrelated to biliary tract disease). Two of 91 patients who had been rendered stone free were readmitted because of recurrent stone disease during the follow-up period. Of the 43 patients who still had their gallbladders during extracorporeal shock-wave lithotripsy, 14% subsequently underwent cholecystectomy. These data show that extracorporeal shock-wave lithotripsy of bile duct stones is a useful and safe adjunct to nonsurgical procedures for the removal of calculi in the biliary tree.
在5年期间，103例胆管结石老年患者（平均年龄70岁，结石主要无法通过内镜取出）使用第一代肾结石碎石机接受了辅助体外冲击波碎石术。92%的患者平均经过1.4次治疗后结石被击碎。四分之一的患者结石碎片自行排入十二指肠，75%的患者需要通过内镜取出碎片，103例患者中有91例（88%）胆管结石完全清除。最重要的不良反应是4%的患者在体外冲击波碎石术后发生败血症。30天死亡率为1%（1例患者），另外15例患者在平均26±14个月的随访期间死亡（主要死于与胆道疾病无关的原因）。91例结石清除患者中有2例在随访期间因结石复发再次入院。在体外冲击波碎石术时仍保留胆囊的43例患者中，14%随后接受了胆囊切除术。这些数据表明，胆管结石体外冲击波碎石术是胆道系统结石非手术治疗的一种有用且安全的辅助方法。
