Zeman R K, Davros W J, Goldberg J A, Fanney D, Forer L E, Garra B S, Hayes W S, Horii S C, Cooper C J, Silverman P M
Department of Radiology, Georgetown University Medical Center, Washington, DC 20007.
AJR Am J Roentgenol. 1991 Oct;157(4):747-52. doi: 10.2214/ajr.157.4.1892029.
The Siemens Lithostar Plus protocol (Siemens Medical Systems, Iselin, NJ) allows investigators to perform gallstone lithotripsy on patients regardless of the number of stones they have, provided the stones occupy less than 50% of the gallbladder lumen. The purpose of this study was to determine the interrelationships between stone burden, fragmentation response, and stone-free rates when treatment is not limited to three stones or fewer. Of 200 patients initially examined, 80 (40%) underwent lithotripsy. The mean number of treatments per patient was 2.1, and the mean number of shock waves per patient was 7386. In 60 patients in whom 6-month follow-up was available, the overall stone-free rate, based on actual results, was 32% (19/60). The stone-free rates for solitary stones, two or three stones, and four or more stones were 50%, 12%, and 26%, respectively. Regardless of number of stones, patients who ultimately became stone free had significantly smaller mean fragment size (0.25 cm) 2 weeks after lithotripsy than did those who did not become stone free (0.51 cm). Retrospective volume analysis showed that seven (47%) of 15 patients with multiple stones occupying less than 2000 mm3 were stone free; none became stone free when this volume was exceeded. Lithotripsy remains a practical option for patients with solitary stones. Comparable stone-free rates to those achieved for solitary stones can be obtained in patients with multiple stones, regardless of their number, provided treatment is aggressive and the stone aggregate is less than 2000 mm3.
西门子Lithostar Plus协议（西门子医疗系统公司，新泽西州伊塞尔林）允许研究人员对患有胆结石的患者进行碎石治疗，无论其结石数量多少，只要结石占据的胆囊腔小于50%即可。本研究的目的是确定在治疗不限于三块或更少结石的情况下，结石负荷、碎石反应和无结石率之间的相互关系。在最初检查的200例患者中，80例（40%）接受了碎石治疗。每位患者的平均治疗次数为2.1次，每位患者的平均冲击波次数为7386次。在60例有6个月随访资料的患者中，根据实际结果，总体无结石率为32%（19/60）。单个结石、两个或三个结石以及四个或更多结石的无结石率分别为50%、12%和26%。无论结石数量多少，最终无结石的患者在碎石治疗后2周的平均碎片尺寸（0.25 cm）明显小于未无结石的患者（0.51 cm）。回顾性体积分析显示，15例结石体积小于2000 mm³的多发结石患者中有7例（47%）无结石；当超过这个体积时，无一例无结石。对于单个结石患者，碎石术仍然是一种可行的选择。对于多发结石患者，无论结石数量多少，只要积极治疗且结石总体积小于2000 mm³，就可以获得与单个结石患者相当的无结石率。
