Khouri M R, Goldszmidt J B, Laufer I, Arger P, Marcus A, Wisniewski F, Ekberg O, Malet P F
Department of Medicine, University of Pennsylvania, Philadelphia.
Radiology. 1990 Oct;177(1):147-51. doi: 10.1148/radiology.177.1.2204959.
Ultrasound is used after extracorporeal shock wave lithotripsy of gallbladder stones to assess fragmentation. In many patients with apparently successful fragmentation, the posttreatment studies show an intraluminal, echogenic focus within the gallbladder, with posterior acoustic shadowing characteristic of an intact stone. Cholesterol gallstones were fragmented in vitro by means of lithotripsy, and the sonographic appearance of the fragmented stones was followed up over time to study factors that might affect the process. After lithotripsy, fragments settled and produced an echogenic focus with posterior shadowing indistinguishable from the appearance of an intact stone. These experimental observations led to the development of a clinical maneuver to overcome the diagnostic pitfalls posed by the reaggregation of stone fragments in situ. This rollover maneuver helps distinguish between intact stones and fragments, and prevents both diagnostic errors in follow-up and unnecessary retreatment.
体外冲击波碎石治疗胆囊结石后，会使用超声来评估结石破碎情况。在许多看似碎石成功的患者中，治疗后的检查显示胆囊腔内有一个强回声灶，其后伴有完整结石特征性的声影。通过碎石术在体外将胆固醇结石破碎，并随时间对破碎结石的超声表现进行随访，以研究可能影响该过程的因素。碎石术后，碎片沉淀并产生一个强回声灶，其后的声影与完整结石的表现难以区分。这些实验观察结果促成了一项临床操作的发展，以克服结石碎片原位重新聚集所带来的诊断陷阱。这种翻转操作有助于区分完整结石和碎片，防止随访中的诊断错误以及不必要的再次治疗。
