Meiser G, Heinerman M, Boeckl O
I. Chirurgische Abteilung und Ludwig-Boltzmann-Institut für experimentelle und gastroenterologische Chirurgie, Landeskrankenanstalten Salzburg.
Chirurg. 1990 May;61(5):370-5.
Extracorporeal shock-wave lithotripsy (BESWL) using the "Obertisch" module Lithostar Plus (Siemens AG) was carried out in 100 patients, comprising a total of 189 gallbladder stones with a size range from 8 to 35 mm. Chenodeoxycholic and ursodeoxycholic acid was given as adjuvant litholytic therapy, beginning 14 days before treatment. 53% of the patients suffered from radiolucent solitary stones with an average size of 21 +/- 6 mm. 14% had more than 3 stones, another 12% had solitary stones with a small rim calcification. In 99 patients all stones could be disintegrated. In 90% we achieved a fragment size smaller than 5 mm, in 10% smaller than 8 mm. 68 patients were treated in a single session, in 32% a 2nd or 3rd treatment was necessary. In the average 4100 +/- 2200 shock-waves with energy level 9 (650 bar) were applied. During treatment 15 patients suffered from slight right kidney pain. In the following 48 hours after BESWL we observed a transitory significant elevation of transaminases (32%), urinary amylases without clinical symptoms (31%), bilirubin (31%) and white blood cells (71%). A microhematuria was seen in 33%, a macrohematuria in 2%. Post-BESWL sonographically we found a transitory edema of the gallbladder wall in 18%, in 15% a hydrops, in 10% a dilatation of the common bile duct and in 4% free fluid surrounding the gallbladder. After dismission 31% of the patients suffered from slight colicky pain. In 3 patients acute biliary pancreatitis was observed 4 and 8 weeks after BESWL which could be treated by EPT and endoscopic stone removal.
使用“Obertisch”模块Lithostar Plus（西门子公司）对100例患者进行体外冲击波碎石术（BESWL），这些患者共有189颗胆囊结石，大小在8至35毫米之间。在治疗前14天开始给予鹅去氧胆酸和熊去氧胆酸作为辅助溶石治疗。53%的患者患有透X线的孤立结石，平均大小为21±6毫米。14%的患者有3颗以上结石，另外12%有带小边缘钙化的孤立结石。99例患者的所有结石均被击碎。90%的患者结石碎片小于5毫米，10%小于8毫米。68例患者接受单次治疗，32%的患者需要进行第二次或第三次治疗。平均施加了4100±2200次能量水平为9（650巴）的冲击波。治疗期间，15例患者出现轻微右肾疼痛。在BESWL后的接下来48小时内，我们观察到转氨酶短暂显著升高（32%）、无临床症状的尿淀粉酶升高（31%）、胆红素升高（31%）和白细胞升高（71%）。33%的患者出现镜下血尿，2%出现肉眼血尿。BESWL后超声检查发现18%的患者胆囊壁有短暂水肿，15%有积水，10%胆总管扩张，4%胆囊周围有游离液体。出院后，31%的患者有轻微绞痛。3例患者在BESWL后4周和8周观察到急性胆源性胰腺炎，可通过内镜逆行胰胆管造影术（EPT）和内镜下取石治疗。
