Tsuchiya Y, Takanashi H, Haniya K, Nishiarai H, Mikami S, Natsuki Y, Kuniyuki H, Saito H, Saito N, Ohto M
First Department of Medicine, Chiba University School of Medicine, Japan.
J Gastroenterol Hepatol. 1994 Nov-Dec;9(6):597-603. doi: 10.1111/j.1440-1746.1994.tb01568.x.
Piezoelectric extracorporeal litotripsy was performed in 128 symptomatic patients with radiolucent gall-bladder stones to assess the significance of disintegration in fragment clearance. Up to 10 repeat lithotripsy sessions were scheduled to achieve a fragment target size of < 3 mm. Fragmentation assessed by the size of the largest fragments after the last session was graded into three classes. I: sludge-like disintegration, 18%; II: < 3 mm (mean +/- s.d., 1.7 +/- 0.5 mm), 56%; and III: > or = 3 mm (3.3 +/- 0.6), 26%. All patients were initially subjected to lithotripsy alone. Bile acid dissolution therapy was started only when ultrasonography failed to show the evidence of decrease in the < 3 mm fragments during a 1 month follow up. Finally, 69 patients (54%) were treated by lithotripsy alone, and the remaining 59 received additional dissolution therapy at a mean period of 2.5 months after the initial lithotripsy. The rate of complete clearance in class I, II and III patients was 91, 42 and 10% at 6 months and 100, 68 and 49% at 18 months, respectively. Significant differences were noted between the three fragmentation grades (I vs II, III, P < 0.0001; II vs III, P < 0.02). The patients with complete clearance within 6 months were seen only in those treated by lithotripsy alone, while the majority (87%) of patients with complete clearance during the later period were seen in those treated by additional dissolution therapy. We conclude that a high degree of fragmentation appears to lead stones to an earlier period clearance, and reduce the need for dissolution therapy.
对128例有症状的胆囊阴性结石患者进行了压电式体外冲击波碎石术，以评估结石碎裂在碎片清除中的意义。计划进行多达10次重复碎石术，以使碎片目标尺寸<3mm。根据最后一次治疗后最大碎片的大小评估碎裂情况，分为三个等级。I级：泥样碎裂，18%；II级：<3mm（平均±标准差，1.7±0.5mm），56%；III级：≥3mm（3.3±0.6），26%。所有患者最初仅接受碎石术。仅在1个月的随访期间超声检查未显示<3mm碎片减少的证据时，才开始胆汁酸溶解治疗。最后，69例患者（54%）仅接受了碎石术治疗，其余59例在初次碎石术后平均2.5个月接受了额外的溶解治疗。I级、II级和III级患者在6个月时的完全清除率分别为91%、42%和10%，在18个月时分别为100%、68%和49%。三个碎裂等级之间存在显著差异（I级与II级、III级比较，P<0.0001；II级与III级比较，P<0.02）。6个月内完全清除的患者仅见于仅接受碎石术治疗的患者，而后期完全清除的患者大多数（87%）见于接受额外溶解治疗的患者。我们得出结论，高度碎裂似乎能使结石更早清除，并减少溶解治疗的需求。
