Manzoor Ul Haque Muhammad, Hassan Luck Nasir, Ali Tasneem Abbas, Mudassir Laeeq Syed, Mandhwani Rajesh, Hanif Farina M, Ullah Lail Ghulam
Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan.
J Transl Int Med. 2020 Sep 25;8(3):159-164. doi: 10.2478/jtim-2020-0025. eCollection 2020 Sep.
Extracorporeal shock wave lithotripsy (ESWL) for common bile duct (CBD) stones has been used in the past, but experience is limited. We report our experience of ESWL in the management of difficult CBD stones.
Patients with difficult-to-retrieve CBD stones were enrolled and underwent ESWL. Fluoroscopy is used to target the stones after injection of contrast via nasobiliary drain. CBD clearance was the main outcome of the study.
Eighty-three patients were included (mean age 50.5 14.5 years); these patients were mainly females (43; 51.8%). Large stones >15 mm were noted in 64 (77.1%), CBD stricture in 22 (26.5%) and incarcerated stone in 8 (9.6%) patients. Patients needed 2.1 ± 1.2 sessions of lithotripsy and 4266 ± 1881 shock waves per session. In 75 (90.3%) patients, the fragments were extracted endoscopically after ESWL, while spontaneous passage was observed in 8 (9.6%). Total CBD clearance was achieved in 67 (80.6%) patients, partial clearance in 5 (6%) and no response in 11 (13.2%). Failure of the treatment was observed in large stone with size ≥2 cm ( = 0.021), incarcerated stone ( = 0.020) and pre-endoscopic retrograde cholangiopancreatography cholangitis ( = 0.047).
ESWL is a noninvasive, safe and effective therapeutic alternative to electrohydraulic lithotripsy and surgical exploration for difficult biliary stones.
过去已将体外冲击波碎石术（ESWL）用于胆总管（CBD）结石，但经验有限。我们报告我们在处理困难性CBD结石时应用ESWL的经验。
纳入难以取出的CBD结石患者并接受ESWL治疗。经鼻胆管引流注入造影剂后，利用荧光镜检查定位结石。CBD结石清除情况是本研究的主要观察指标。
纳入83例患者（平均年龄50.5±14.5岁）；这些患者以女性为主（43例；51.8%）。64例（77.1%）患者存在>15mm的大结石，22例（26.5%）患者存在CBD狭窄，8例（9.6%）患者存在嵌顿性结石。患者每次碎石需要2.1±1.2个疗程，每个疗程需要4266±1881次冲击波。75例（90.3%）患者在ESWL后通过内镜取出碎片，8例（9.6%）患者观察到结石自行排出。67例（80.6%）患者实现了CBD结石完全清除，5例（6%）部分清除，11例（13.2%）无反应。在结石大小≥2cm的大结石患者（P=0.021）、嵌顿性结石患者（P=0.020）和内镜逆行胰胆管造影术前胆管炎患者（P=0.047）中观察到治疗失败。
对于困难性胆管结石，ESWL是一种无创、安全且有效的治疗选择，可替代电液压碎石术和手术探查。
