Mousavi Seyed Abdollah, Karami Hasan, Barzegarnejad Ayub
Department of Pediatric Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Pediatric Gastroenterology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
J Indian Assoc Pediatr Surg. 2014 Oct;19(4):218-21. doi: 10.4103/0971-9261.142010.
The most common etiology for gallstones in children is hemolytic diseases; however, the prevalence of nonhemolytic gallstones, which are mostly idiopathic, is increasing. Several studies concerning the treatment of gallstones with respect to the influence of extracorporeal shock wave lithotripsy (ESWL) have been conducted in adults, but not to the same extent in children. Therefore, this study attempted to examine the effects of lithotripsy on idiopathic gallstones in children.
In this study, 12 children, all of whom were under 12 years of age and diagnosed with idiopathic gallstones, were treated with ESWL. The average age of the children examined in this study was 6.5 years (range 3-11 years). Patients were treated with 2500-3000 shockwaves per session. The number of shockwaves was 90 shocks/min and the impulse intensity ranged from 10 to 12 kV. The final goal was the fragmentation of stones in pieces with less than 3 mm in dimension. Patients were followed up for 6-30 months.
A total of 12 patients were treated with ESWL for 14 rounds. In three patients, complete fragmentation occurred within the first trial and was cleared. The nine remaining patients underwent ESWL 10 times in which an acceptable change in the gallstone's condition was not observed. Five of the patients underwent surgery. The chemical composition of the gallstones showed that the dominant element in them was calcium.
Our findings show that performing ESWL can be effective in some children. Further studies with larger population are recommended. Furthermore, it seems increasing the voltage intensity and frequency as conducted in adults accompanied with biliary acids prescription can be effective in children.
儿童胆结石最常见的病因是溶血性疾病；然而，非溶血性胆结石（大多为特发性）的患病率正在上升。关于体外冲击波碎石术（ESWL）对胆结石治疗影响的多项研究已在成人中开展，但在儿童中的研究程度不同。因此，本研究试图探讨碎石术对儿童特发性胆结石的影响。
本研究中，12名12岁以下被诊断为特发性胆结石的儿童接受了ESWL治疗。本研究中接受检查的儿童平均年龄为6.5岁（范围3 - 11岁）。患者每次接受2500 - 3000次冲击波治疗。冲击波数量为90次/分钟，脉冲强度范围为10至12 kV。最终目标是将结石碎成尺寸小于3毫米的碎片。对患者进行了6 - 30个月的随访。
共有12名患者接受了14轮ESWL治疗。3名患者在首次治疗时结石完全破碎并排出。其余9名患者接受了10次ESWL治疗，但胆结石状况未观察到可接受的变化。其中5名患者接受了手术。胆结石的化学成分显示，其中的主要成分是钙。
我们的研究结果表明，对部分儿童实施ESWL可能有效。建议开展更大规模人群的进一步研究。此外，似乎像成人那样增加电压强度和频率并同时开具胆汁酸处方可能对儿童有效。
