Frick T, Hoffmann R, Largiadèr F, Ammann R, Häcki W, Fuchs W
Klinik für Viszeralchirurgie (Departement Chirurgie), Universitätsspital Zürich.
Schweiz Med Wochenschr. 1991 Jul 20;121(29):1049-54.
The effect of extracoporeal shockwave lithotripsy (ESWL) in combination with oral chemolitholysis on gallstone clearance was tested in a prospective study. We used a non-waterbath lithotripter, and the patients were treated without general anesthesia or intravenous analgesia. They solely received oral or subcutaneous premedication. Within the 30 months study-period 78 patients were selected according to the "Munich-criteriae". At the end of the study period 33 patients were free of stones, 20 patients had residual fragments, and 25 patients stopped the therapy prior to complete stone clearance because of compliance (n = 11), or methodological (n = 14) problems. This includes 3 patients in whom the ESWL had to be discontinued because of pain. No severe complications were seen with the exception of one attack of acute pancreatitis, from which the patient recovered. The rate of stone clearance was analyzed using the life-table calculation according to KAPLAN-MEIER to weigh the follow-up time of each patient. At 12 months it revealed a stonefree rate of 70% in patients who did not discontinue the treatment because of methodological problems. The advantage of ESWL is the possibility to treat gallstones without general anesthesia or intravenous analgesia. However, the patient-population must be highly selected, and there is the risk of recurrence.
在一项前瞻性研究中，测试了体外冲击波碎石术（ESWL）联合口服溶石疗法对胆结石清除率的影响。我们使用了非水浴碎石机，患者在无全身麻醉或静脉镇痛的情况下接受治疗。他们仅接受口服或皮下术前用药。在30个月的研究期内，根据“慕尼黑标准”选择了78例患者。在研究期结束时，33例患者结石消失，20例患者有残留碎片，25例患者因依从性问题（n = 11）或方法学问题（n = 14）在结石完全清除前停止治疗。这包括3例因疼痛而不得不停止ESWL治疗的患者。除1例急性胰腺炎发作且患者已康复外，未观察到严重并发症。根据KAPLAN - MEIER法使用生命表计算分析结石清除率，以权衡每位患者的随访时间。在12个月时，未因方法学问题而停止治疗的患者结石清除率为70%。ESWL的优点是无需全身麻醉或静脉镇痛即可治疗胆结石。然而，必须对患者群体进行严格筛选，且存在复发风险。
