Callans L S, Gadacz T R
Department of Surgery, Baltimore Veterans Administration Medical Center, MD 21218.
Surgery. 1990 Feb;107(2):121-7.
In vitro fragmentation of gallstones was performed by means of ultrasound (n = 89) and electrohydraulic lithotripsy (n = 83) with success rates of 100% and 93%, respectively. The fragmentation time was 21.9 +/- 52 seconds (mean +/- SEM) for ultrasound and 2.5 +/- 3.4 seconds for electrohydraulic lithotripsy. The energies required were similar to those used safely in the fragmentation of renal and bladder stones. Fragmentation was not related to the composition of the gallstones; there was no statistical difference between the fragmentation times or rates (p greater than 0.05) in cholesterol stones and pigment stones by either method. Fragmentation time was linearly related to gallstone weight for both methods. Comparison of ultrasound and electrohydraulic lithotripsy, using the two-way analysis of variance model, revealed no statistical difference between the two methods in times and rates of fragmentation (p greater than 0.05). Both ultrasound and electrohydraulic lithotripsy offer distinct advantages over the dissolution of gallstones by chemical methods because they are rapid and independent of gallstone composition. In vivo fragmentation of a large pigment common duct stone was also accomplished by means of an electrohydraulic lithotriptor. The stone was discovered in a 79-year-old patient on post-operative T-tube cholangiogram. Chemical analysis of the gallstones removed from the patient during cholecystectomy had revealed a very low cholesterol content. Since the remaining stone could not be dissolved and was too large to be mechanically extracted, it was fragmented through a T-tube, under fluoroscopic guidance and the small fragments were extracted with a dormia basket. The electrohydraulic lithotriptor was selected because it has a flexible probe.
采用超声（n = 89）和液电碎石术（n = 83）对胆结石进行体外破碎，成功率分别为100%和93%。超声破碎时间为21.9±52秒（平均值±标准误），液电碎石术为2.5±3.4秒。所需能量与肾和膀胱结石破碎时安全使用的能量相似。结石破碎与胆结石的成分无关；两种方法对胆固醇结石和色素结石的破碎时间或破碎率均无统计学差异（p＞0.05）。两种方法的破碎时间均与胆结石重量呈线性相关。采用双向方差分析模型比较超声和液电碎石术，结果显示两种方法在破碎时间和破碎率方面无统计学差异（p＞0.05）。与化学方法溶解胆结石相比，超声和液电碎石术均具有明显优势，因为它们速度快且与胆结石成分无关。还通过液电碎石器完成了一例胆总管大色素结石的体内破碎。在一名79岁患者术后T管胆管造影时发现了该结石。对患者胆囊切除术中取出的胆结石进行化学分析，结果显示胆固醇含量极低。由于剩余结石无法溶解且体积过大无法机械取出，遂在荧光透视引导下通过T管将其破碎，并用Dormia网篮取出小碎片。选择液电碎石器是因为它有一个可弯曲的探头。
