Soehendra N, Nam V C, Binmoeller K F, Koch H, Bohnacker S, Schreiber H W
Department of Endoscopic Surgery, University Hospital of Hamburg, Germany.
Gut. 1994 Mar;35(3):417-22. doi: 10.1136/gut.35.3.417.
Using a modified electromagnetic lithotripter (Siemens), extracorporeal shock wave lithotripsy (ESWL) was performed in 260 patients with gall bladder stones. Exclusion criteria for treatment were a non-functioning gall bladder, subcostal gall bladder location, and multiple stones occupying more than three quarters of the gall bladder volume. Stone pulverisation was the end point of ESWL. The number of shock wave discharges and sessions was not limited. Pulverisation was achieved in 250 patients (96.1%) after a median of three ESWL sessions (range 1-21). The number of sessions required depended upon stone composition and burden. More than three sessions were required in 60.2% of patients with calcified stones compared with 35.9% of patients with non-calcified stones (p < 0.001). 65.8% of patients with stones measuring more than 30 mm in total diameter required more than three sessions compared with 42.9% of patients with a stone burden less than 30 mm (p < 0.01). At 18-24 (8-12) months follow up, stone clearance was achieved in 94.3% (80.4%) of patients with non-calcified stones, compared with 89.5% (76.8%) in patients with calcified stones and in 75% (71.4%) of patients with a total stone diameter more than 30 mm compared with 95.7% (80.4%) for patients with a total stone diameter less than 30 mm (p < 0.05). ESWL related complications (gross haematuria) occurred in three patients. Thirty six (13.8%) patients experienced biliary colic; four had cholecystectomy, and five endoscopic papillotomy because of common bile duct obstruction. Stone recurrence was seen in 5.3% of patients over a follow up period of up to two years (median 16.6 months).
使用改良的电磁碎石机（西门子），对260例胆囊结石患者进行了体外冲击波碎石术（ESWL）。治疗的排除标准为胆囊无功能、胆囊位于肋缘下以及多个结石占据胆囊体积的四分之三以上。结石粉碎是ESWL的终点。冲击波放电次数和疗程不限。250例患者（96.1%）在中位3次ESWL疗程（范围1 - 21次）后实现了结石粉碎。所需疗程数量取决于结石成分和负荷。60.2%的钙化结石患者需要超过3个疗程，而非钙化结石患者为35.9%（p < 0.001）。结石总直径超过30 mm的患者中，65.8%需要超过3个疗程，而结石负荷小于30 mm的患者为42.9%（p < 0.01）。在18 - 24（8 - 12）个月的随访中，非钙化结石患者的结石清除率为94.3%（80.4%），钙化结石患者为89.5%（76.8%），结石总直径超过30 mm的患者为75%（71.4%），而结石总直径小于30 mm的患者为95.7%（80.4%）（p < 0.05）。3例患者出现了ESWL相关并发症（肉眼血尿）。36例（13.8%）患者发生胆绞痛；4例行胆囊切除术，5例因胆总管梗阻行内镜乳头切开术。在长达两年的随访期内（中位16.6个月），5.3%的患者出现结石复发。
