Weber J, Riemann J F
Medizinische Klinik C, Stadt Ludwigshafen.
Z Gastroenterol. 1991 Apr;29(4):156-62.
More than 90% of all common bile duct stones are today extracted endoscopically after papillotomy with the Dormia basket in combination with the mechanical lithotripter. For patients with endoscopically unremovable stones, there are now new therapies as an alternative to surgical intervention. Ductal stones can either be fragmented by extracorporeal shock wave lithotripsy or by peroral cholangioscopic guided electrohydraulic lithotripsy. The remaining fragments can then be easily extracted endoscopically. If the stone cannot be removed by using these new techniques, a palliative endoprosthesis can by implanted. We report on our experiences and results with the extracorporeal piezoelectric shock wave lithotripsy and the intracorporeal electrohydraulic therapy in 44 patients with complicated bile duct stones. Applying extracorporeal shock wave therapy, treatment was successful in 75% of the patients with common bile duct stones, intracorporeal electrohydraulic lithotripsy was successful in 71%. By combination of both techniques, the calculi could be removed in 84% of those patients where before one of both therapies had failed. Finally, the rate of success in the above mentioned 44 patients was 93%. It could be shown by this investigation that both therapeutic methods complete each other in the treatment of the complicated common bile duct stones.
如今，超过90%的胆总管结石在乳头切开术后通过使用多尔米亚网篮结合机械碎石器经内镜取出。对于内镜下无法取出结石的患者，现在有了新的治疗方法作为手术干预的替代方案。胆管结石既可以通过体外冲击波碎石术破碎，也可以通过经口胆管镜引导下的液电碎石术破碎。然后，剩余的结石碎片可以很容易地经内镜取出。如果使用这些新技术无法取出结石，可以植入姑息性内支架。我们报告了44例复杂性胆管结石患者接受体外压电冲击波碎石术和体内液电治疗的经验和结果。应用体外冲击波治疗，75%的胆总管结石患者治疗成功，体内液电碎石术的成功率为71%。通过两种技术联合应用，在两种治疗方法之一之前失败的患者中，84%的结石可以被取出。最后，上述44例患者的成功率为93%。这项研究表明，两种治疗方法在治疗复杂性胆总管结石方面相辅相成。
