Shock-Wave Lithotripsy of Gallbladder Stones

作者：Michael F. Sackmann, Michael Delius, Tilman Sauerbruch, Joseph Holl, Werner Weber, Ernst Ippisch, Ulrich Hagelauer, Othmar J. Wess, W. Hepp, WALTER BRENDEL, Gustav Paumgartner · 发表于：New England Journal of Medicine · 年份：1988 · DOI：10.1056/nejm198802183180701 · 被引用次数：505 · 研究领域：Gallbladder and Bile Duct Disorders、Abdominal Trauma and Injuries、Kidney Stones and Urolithiasis Treatments

To substantiate the early results of extracorporeal shock-wave fragmentation of gallstones, we used this nonsurgical procedure to treat 175 patients with radiolucent gallbladder calculi. Chenodeoxycholic acid and ursodeoxycholic acid were administered as adjuvant litholytic therapy. The gallstones disintegrated in all patients except one and completely disappeared in 30 percent of all patients within 2 months after lithotripsy, in 48 percent at 2 to 4 months, in 63 percent at 4 to 8 months, in 78 percent at 8 to 12 months, and in 91 percent at 12 to 18 months. In patients with solitary stones up to 20 mm in diameter, the corresponding values were 45, 69, 78, 86, and 95 percent, respectively. Shock-wave therapy had no adverse effects except cutaneous petechiae (14 percent) and transient gross hematuria (3 percent). One third of the patients had one or more episodes of biliary colic before all the fragments disappeared. Two patients had mild pancreatitis, which necessitated endoscopic sphincterotomy in one. The patient with insufficient stone fragmentation underwent elective cholecystectomy; no additional operations were necessary. Extracorporeal shock-wave lithotripsy combined with medical therapy for stone dissolution is a safe and effective treatment in selected patients with radiolucent gallbladder calculi.