Elewaut A, Crape A, Afschrift M, Pauwels W, De Vos M, Barbier F
University Hospital Gent, Department of Internal Medicine, Belgium.
Gut. 1993 Feb;34(2):274-8. doi: 10.1136/gut.34.2.274.
During a period of 24 months 693 consecutive patients with symptomatic gall bladder stones (526 males, 167 females; mean age 51 years, range 18-89) were treated by extracorporeal shock wave lithotripsy with a Piezolith 2300. The procedure was carried out on an out-patient basis without analgesics or sedatives. Concomitant chemolitholytic treatment (ursodeoxycholic and chenodeoxycholic acid 7.5 mg/kg/day each) was administered until three months after total fragment clearance for a maximum therapy period of 1.5 years. In 601 patients with radiolucent stones complete clearance of all fragments was obtained after three, six, 12, and 18 months in respectively 20, 41, 64, and 78%. Actuarial analysis of the subgroups according to the stone mass (size and number) selected an ideal patient population with solitary stones less than 20 mm diameter (84% stone free after one year). The results are significantly less good when the greater the number of stones or their maximal diameter increases. Treatment was interrupted in 3.6% of the patients. In 90 sludge or fragments remain present. Twenty five patients were lost to follow up for non-biliary reasons. Stone recurrence was 5.7% at one year and was observed both in patients with solitary and multiple stones. A cost effectiveness analysis suggests that laparoscopic cholecystectomy is the most effective and economic solution, although extracorporeal shock wave lithotripsy for solitary radiolucent stones less than 2 cm is cheaper than conventional cholecystectomy. Extracorporeal shock wave lithotripsy for multiple stones is the most expensive and least effective option.
在24个月期间，使用Piezolith 2300型体外冲击波碎石机对693例有症状胆囊结石患者（526例男性，167例女性；平均年龄51岁，范围18 - 89岁）进行了连续治疗。该手术在门诊进行，无需使用镇痛药或镇静剂。同时给予溶石治疗（熊去氧胆酸和鹅去氧胆酸各7.5 mg/kg/天），持续至结石碎片完全清除后三个月，最长治疗期为1.5年。在601例透X线结石患者中，分别在3个月、6个月、12个月和18个月时，结石碎片完全清除的比例为20%、41%、64%和78%。根据结石大小和数量对亚组进行精算分析，选出了理想的患者群体，即直径小于20 mm的单发结石患者（一年后结石清除率为84%）。结石数量越多或最大直径越大，结果越不理想。3.6%的患者治疗中断。90例患者仍有胆泥或碎片残留。25例患者因非胆源性原因失访。一年时结石复发率为5.7%，单发和多发结石患者均有复发。成本效益分析表明，腹腔镜胆囊切除术是最有效和经济的解决方案，尽管对于直径小于2 cm的单发透X线结石，体外冲击波碎石术比传统胆囊切除术便宜。对于多发结石，体外冲击波碎石术是最昂贵且最无效的选择。
