Schreiber F, Brandstätter G, Pristautz H, Wenzl H, Savli H, Kronawetter M
Medizinische Univ. Klinik Graz.
Z Gastroenterol. 1991 Sep;29(9):429-32.
A huge common bile duct stone of 6 to 3 cm in diameter in a 64 year old lady was approached by ESWL, after endoscopic therapy such as mechanical lithotripsy and removal with the Dormia basket had failed because of the extraordinary size of this stone. A surgical therapy was not possible because of pronounced vascular and cardiopulmonary risk, so ESWL was applied to this patient. The stone was fragmented in two sessions of ESWL under sonographic targeting and the fragments were removed endoscopically. After one month one fragment still remained in the common bile duct, which then was removed also endoscopically. Two months later the ERC showed a stone-free common bile duct. This case demonstrates, that even common bile duct stones of extraordinary size can be removed by combining ESWL with endoscopic techniques. Following the trend to minimally invasive therapy, sonography should be preferred over XRay in diagnosis before ESWL as well as during ESWL.
一名64岁女性患有直径达6至3厘米的巨大胆总管结石。在内镜治疗（如机械碎石术和使用多尔米亚篮取出）因结石尺寸异常而失败后，采用了体外冲击波碎石术（ESWL）。由于存在明显的血管和心肺风险，无法进行手术治疗，因此对该患者实施了ESWL。在超声引导下，通过两次ESWL治疗将结石击碎，并通过内镜取出碎片。一个月后，胆总管内仍残留一块碎片，随后也通过内镜将其取出。两个月后，内镜逆行胰胆管造影（ERC）显示胆总管无结石。该病例表明，即使是尺寸异常的胆总管结石，通过ESWL与内镜技术相结合也可取出。遵循微创治疗的趋势，在ESWL治疗前及治疗期间的诊断中，超声应优先于X射线。
