Dissolution of cholesterol gallbladder stones by methyl tert-butyl ether administered by percutaneous transhepatic catheter.
Dissolution of cholesterol gallbladder stones by methyl tert-butyl ether administered by percutaneous transhepatic catheter.
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通过经皮肝穿刺导管施用甲基叔丁基醚溶解胆固醇胆囊结石。
DOI：
10.1056/nejm198903093201004
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
McCullough,JE
中科院分区：
文献类型：
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作者：
Thistle,JL;May,GR;Bender,CE;Williams,HJ;LeRoy,AJ;Nelson,PE;Peine,CJ;Petersen,BT;McCullough,JE
我们治疗75例有症状的胆固醇结石患者，通过经皮穿刺导管向胆囊内滴入甲基叔丁基醚（MTBE）溶解结石。MTBE持续输注和手动抽吸，每分钟4至6次，平均每天5小时，持续1至3天;治疗通过荧光透视进行监测。导管的放置和MTBE的给药引起的副作用或并发症很少，任何患者都不必因此而停止治疗。72例患者结石完全溶解或溶解超过95%。治疗后结石完全清除的21例患者中，4例在6 ~ 16个月后结石复发。其他51名患者有残留碎片，其中15名患者在6至35个月内自发完全清除;只有7名持续存在碎片的患者有症状。最初治疗的6例患者中有5例，但在接下来的69例患者中只有1例，在6至42个月的随访期间需要手术，我们得出结论，通过经皮经皮导管输送的MTBE溶解胆结石是一个有用的替代手术在选定的有症状的胆固醇结石患者。需要进一步研究以确定这种治疗的长期有效性及其在各种类型胆结石管理中的适当作用。（N Engl J Med 1989; 320：633-9.）
We treated 75 patients with symptomatic cholesterol gallstones by dissolving the stones with methyltert-butyl ether (MTBE) instilled into the gallbladder through a percutaneous transhepatic catheter. The MTBE was continuously infused and aspirated manually four to six times a minute, for an average of five hours per day for one to three days; the treatment was monitored by fluoroscopy.The placement of the catheter and the administration of MTBE caused few side effects or complications, and treatment did not have to be stopped in any patient for this reason. In 72 patients there was complete dissolution of stones or more than 95 percent dissolution. Among 21 patients who were completely free of stones after treatment, 4 had recurrence of stone formation 6 to 16 months later. The other 51 patients had residual debris, which spontaneously cleared completely in 15 patients within 6 to 35 months; only 7 with persisting debris have had symptoms. Five of the initial 6 patients treated, but only 1 of the next 69 patients, have required surgery during follow-up periods of 6 to 42 months.We conclude that the dissolution of gallstones by MTBE delivered through a percutaneous transhepatic catheter is a useful alternative to surgery in selected patients with symptomatic cholesterol stones. Further study will be necessary to establish the long-term effectiveness of this treatment and its appropriate role in the management of the various types of gallstones. (N Engl J Med 1989; 320:633–9.)