[体内冲击波碎石术治疗胆管复杂性结石。内镜技术比较及长期结果]

Behjou B, Prat F, Fritsch J, Choury A D, Frouge C, Pelletier G, Buffet C

Service des Maladies du Foie et de l'Appareil Digestif, Hôpital de Bicêtre, Le Kremlin-Bicêtre.

Gastroenterol Clin Biol. 1997;21(10):648-54.

OBJECTIVES

About 2% of common bile duct stones and most intra-hepatic stones cannot be removed by conventional endoscopy. Intra-corporeal lithotripsy is an alternative technique for these patients. Contact lithotripsy can be obtained by a pulsed dye laser or by electro-hydraulic shockwaves. We compared and assessed the results of these two methods.

METHODS

Thirty-seven patients (79 +/- 9.8 years, 25 women and 12 men) underwent laser lithotripsy (n = 21), electro-hydraulic lithotripsy (n = 9) or both methods consecutively (n = 7) for common bile duct stones (n = 31), intra-hepatic stones (n = 3) or diffuse lithiasis (n = 3). The mean diameter of the largest stone was 23 +/- 12 mm. Lithotripsy was performed by a retrograde approach in 35 cases and a combined, retrograde and transhepatic approach in 2 cases.

RESULTS

The mean number of lithotripsy sessions was 1.5 +/- 0.65. The overall success rate (free bile ducts with patent drainage) was 95%. In 2 patients, stones were not fully extracted: one underwent surgery, the other one was treated conservatively with antibiotics. The duration of the hospital stay was 9.3 +/- 4.5 days. Morbidity at 30 days was 27% and only one case of major morbidity (hemorrhage after sphincterotomy, 2.7%) was observed. There were no procedure-related mortality. Electro-hydraulic and laser groups did not differ significantly for success rate, morbidity and time spent at hospital. Follow-up information was obtained in 34 patients (91.8%) a median of 17 months after lithotripsy (range: 4.52 months). Ten patients died of non-biliary diseases. Two patients (5.8%) developed biliary symptoms 24 and 34 months after lithotripsy, one after unsuccessful lithotripsy.

CONCLUSION

Intra-corporeal lithotripsy is a valuable tool for the most complex cases of duct stones, and with an acceptable morbidity. The results of the two techniques are similar. Late biliary complications after intra-corporeal lithotripsy appear to be rare.

目的

约2%的胆总管结石及大多数肝内结石无法通过传统内镜取出。体内碎石术是这些患者的一种替代技术。接触式碎石术可通过脉冲染料激光或电液压冲击波实现。我们对这两种方法的结果进行了比较和评估。

方法

37例患者（年龄79±9.8岁，女性25例，男性12例）因胆总管结石（31例）、肝内结石（3例）或弥漫性结石（3例）接受了激光碎石术（21例）、电液压碎石术（9例）或两种方法先后进行（7例）。最大结石的平均直径为23±12mm。35例采用逆行途径进行碎石术，2例采用逆行联合经肝途径。

结果

平均碎石次数为1.5±0.65次。总体成功率（胆管通畅且引流良好）为95%。2例患者结石未完全取出：1例接受了手术，另1例采用抗生素保守治疗。住院时间为9.3±4.5天。30天内的发病率为27%，仅观察到1例严重并发症（括约肌切开术后出血，2.7%）。无手术相关死亡病例。电液压组和激光组在成功率、发病率和住院时间方面无显著差异。34例患者（91.8%）在碎石术后中位17个月（范围：4.5 - 2个月）获得随访信息。10例患者死于非胆道疾病。2例患者（5.8%）在碎石术后24个月和34个月出现胆道症状，1例发生在碎石术失败后。