Lu D S, Ho C S, Allen L C
Department of Radiology, Toronto Hospital, Ontario, Canada.
AJR Am J Roentgenol. 1990 Jul;155(1):67-72. doi: 10.2214/ajr.155.1.2112866.
Twenty sets of three gallstones matched for weight and appearance were selected from 20 surgically resected human gallbladders to test the effect of intracorporeal mechanical fragmentation on gallstone dissolution with methyl tert-butyl ether in vitro. One stone from each set was fragmented by a mechanical lithotriptor and then treated with methyl tert-butyl ether, and one was used as control and was treated intact. The third stone was analyzed for its density pattern on CT and biochemically for its cholesterol and calcium content. On the basis of CT appearance, the stones were classified as noncalcified, partially calcified, or heavily calcified. Mechanical fragmentation reduced dissolution time by 25-69% (mean +/- SD, 44 +/- 16%) for the noncalcified stones and by 20-42% (mean +/- SD, 30 +/- 8%) for the partially calcified stones. No significant reduction was observed for the heavily calcified stones. The degree of reduction was inversely related to maximal stone density (r = -.72) and was independent of its pattern of calcification. This study shows that mechanical fragmentation is effective in accelerating gallstone chemolysis by methyl tert-butyl ether for noncalcified and partially calcified but not for heavily calcified stones.
从20个手术切除的人体胆囊中选取20组重量和外观匹配的三颗胆结石，以测试体外体内机械破碎对甲基叔丁基醚溶解胆结石的影响。每组中的一颗结石用机械碎石器破碎，然后用甲基叔丁基醚处理，另一颗作为对照，完整处理。第三颗结石进行CT密度分析和胆固醇及钙含量的生化分析。根据CT表现，结石分为非钙化、部分钙化或重度钙化。对于非钙化结石，机械破碎使溶解时间缩短了25%-69%（平均±标准差，44±16%），对于部分钙化结石，缩短了20%-42%（平均±标准差，30±8%）。对于重度钙化结石，未观察到显著缩短。缩短程度与结石最大密度呈负相关（r = -0.72），且与钙化模式无关。本研究表明，机械破碎可有效加速甲基叔丁基醚对非钙化和部分钙化胆结石的化学溶解，但对重度钙化结石无效。
