Taylor M C, Marshall J C, Fried L A, LeBrun G P, Norman R W
Department of Surgery, Victoria General Hospital, Nova Scotia, Canada.
Ann Surg. 1988 Nov;208(5):586-92. doi: 10.1097/00000658-198811000-00007.
The use of extracorporeal shock wave lithotripsy (ESWL) in the management of ten patients with complex biliary tract stones is described. General or epidural anesthesia was used in all cases, and stone fragmentation was performed, using an unmodified Dornier HM3 waterbath lithotripter (Dornier Medical Systems Inc., Marietta, GA). In all cases, biliary drainage was established before the procedure to allow contrast visualization during and after the procedure, as well as to ensure free drainage of the common bile duct. Indications for ESWL included failure of basket extraction (4 cases), unfavorable anatomy (duodenal diverticulum, previous Billroth II reconstruction, hepatic duct stone, gallbladder stone, cystic duct remnant stone), and immaturity of the T-tube tract (2 cases). Cholangitis was the presenting diagnosis in four cases. Fragmentation of the stones was successful in all patients; in two cases, two ESWL sessions were needed for stone disruption. Morbidity was minimal (there was a minor elevation of LDH and transaminases and asymptomatic hemobilia and hematuria); pancreatitis did not occur. After ESWL, hospital stays ranged from 1 to 13 days (mean of 5.3 days). ESWL can be a valuable adjunct in the management of patients with complex biliary stones.
本文描述了体外冲击波碎石术（ESWL）在10例复杂性胆管结石患者治疗中的应用。所有病例均采用全身麻醉或硬膜外麻醉，使用未改良的多尼尔HM3水浴碎石机（多尼尔医疗系统公司，佐治亚州玛丽埃塔）进行结石粉碎。所有病例在手术前均建立胆管引流，以便在手术期间和术后进行造影剂显影，并确保胆总管的通畅引流。ESWL的适应证包括取石篮取石失败（4例）、解剖结构不利（十二指肠憩室、既往毕罗Ⅱ式重建、肝管结石、胆囊结石、胆囊管残余结石）以及T形管通道未成熟（2例）。4例患者以胆管炎为首发诊断。所有患者的结石粉碎均获成功；2例患者需要进行两次ESWL治疗以粉碎结石。并发症极少（乳酸脱氢酶和转氨酶轻度升高，无症状性胆血瘘和血尿）；未发生胰腺炎。ESWL治疗后，住院时间为1至13天（平均5.3天）。ESWL在复杂性胆管结石患者的治疗中可作为一种有价值的辅助手段。
