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[体外冲击波碎石术治疗胆囊结石一年后的结果]

[One year results after extracorporeal shock wave lithotripsy of gallbladder stones].

作者信息

Orosz P, Juhász L, Nagy G

机构信息

Borsod-Abaúj-Zemplén Megyei Kórház, Miskolc, II. Belgyógyászat.

出版信息

Orv Hetil. 1994 Oct 23;135(43):2357-61.

PMID:7970653
Abstract

512 patients with gallbladder stones (393 females, mean age 52.7 years; 119 males, mean age 46.9 years) were treated by extracorporeal shock wave lithotripsy with an electrohydraulic Dornier MPL 9000 lithotripter. The Munich criteria were used for patients selection. Midazolam (15 mg im) and piritramid (mean 7.5 mg iv) were administered as analgetics. Stone fragmentation was achieved after an average of 1.92 treatment sessions. In 12 cases (2.3%) there was no fragmentation. Ursodeoxycholic acid (10 mg/kg/day) was administered as adjuvant litholytic therapy until 3 months after total fragment clearance. During a period of a year the patients returned for follow-up investigations in decreasing number. The total fragment clearance rate was 43.3%, for the I. group (single stone of 5 to 20 mm) was 58%, for the II. group (single stone of 21 to 30 mm) was 28.6%, for the III. group (2 or 3 stones of 30 mm maximum diameter) was 21.4%. In 12 cases (1.2%) vasovagal reactions, in 31 cases (3.1%) atrial and ventricular extrasystoles, in 27 cases (2.7%) transient gross hematuria were observed. During a period of a year 18 cholecystitis (3.5%), 8 pancreatitis (1.56%) and 5 obstructive jaundice (0.97%) developed. 28 cholecystectomies (5.4%), 1 necrectomy because of necrotic pancreatitis (0.19%) and 5 endoscopic sphincterotomies (0.97%) were required.

摘要

512例胆囊结石患者(女性393例,平均年龄52.7岁;男性119例,平均年龄46.9岁)接受了体外冲击波碎石术,使用的是多尼尔MPL 9000型液电碎石机。采用慕尼黑标准选择患者。使用咪达唑仑(15 mg肌肉注射)和匹利卡明(平均7.5 mg静脉注射)作为镇痛药。平均经过1.92次治疗后结石被击碎。12例(2.3%)未出现结石破碎。熊去氧胆酸(10 mg/kg/天)作为辅助溶石治疗,持续使用至结石完全清除后3个月。在一年的时间里,患者前来进行随访检查的人数逐渐减少。结石完全清除率为43.3%,I组(单个结石直径5至20 mm)为58%,II组(单个结石直径21至30 mm)为28.6%,III组(最大直径30 mm的2个或3个结石)为21.4%。观察到12例(1.2%)出现血管迷走反应,31例(3.1%)出现房性和室性早搏,27例(2.7%)出现一过性肉眼血尿。在一年的时间里,发生了18例胆囊炎(3.5%)、8例胰腺炎(1.56%)和5例梗阻性黄疸(0.97%)。需要进行28例胆囊切除术(5.4%)、1例因坏死性胰腺炎进行的坏死组织切除术(0.19%)和5例内镜下括约肌切开术(0.97%)。

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