The Munich Gallbladder Lithotripsy Study. Results of the first 5 years with 711 patients.
The Munich Gallbladder Lithotripsy Study. Results of the first 5 years with 711 patients.
复制标题
慕尼黑胆囊碎石术研究。
DOI：
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发表时间：
1991
影响因子：
39.2
通讯作者：
Gustav Paumgartner
中科院分区：
文献类型：
--
作者：
M. Sackmann;J. Pauletzki;Tilman Sauerbruch;J. Holl;G. Schelling;Gustav Paumgartner
客观化
目的：评价三种冲击波治疗透射线胆囊结石的远期疗效。
设计
队列研究。
设置
单中心试验。
病人
在5824名胆结石患者中，19%符合条件；711名患者接受了治疗。
干预措施
患者接受体外冲击波碎石术和胆汁酸辅助治疗。
结果
分别采用水箱碎石机(A组)、低能量水垫式碎石机(B组)和高能水垫式碎石机(C组)三种方式碎石。碎石后9~12个月碎石完全清除率A组为76%，B组为60%，C组为83%，三组间差异有统计学意义(P=0.03)。单发结石直径21~30 mm，A组碎石清除率为63%，B组为32%，C组为58%(P<0.005)。在2个或3个结石的患者中，A组碎石清除率为38%，B组为16%，C组为46%(P=0.01)。碎石后24小时碎石块直径小于或等于3 mm的患者碎石块消失的概率高于碎石块较大的患者(P<0.001)。胆酸治疗顺从者的清除率高于胆酸治疗不顺应者(P<0.001)。不良反应包括肝脏血肿1例，胆道疼痛发作253例(36%)，轻度胆源性胰腺炎13例(2%)，胆汁淤积7例(1%)。择期手术16例(2%)，内窥镜下括约肌切开术4例(1%)。
结论
冲击波治疗后结石完全消失率取决于初始结石的大小和数量、最大碎石的直径和冲击波治疗方式。胆汁酸的辅助治疗对于完全清除碎片似乎很重要。
OBJECTIVE
To evaluate the long-term results of three types of shock wave treatment in patients with radiolucent gallbladder stones.
DESIGN
Cohort study.
SETTING
Single-center trial.
PATIENTS
Of 5824 patients with gallstones, 19% were eligible; 711 patients were treated.
INTERVENTIONS
Patients received extracorporeal shock wave lithotripsy as well as adjuvant therapy with bile acids.
RESULTS
Lithotripsy was done in three ways, using a water-tank lithotriptor (group A), a water-cushion lithotriptor at low energy levels (group B), and a water-cushion lithotriptor at high energy levels (group C). The rate of complete fragment clearance 9 to 12 months after lithotripsy was done differed significantly among the three groups: Among patients with single stones of 20 mm or less in diameter, the rate of fragment clearance for group A was 76%; for group B, it was 60%; and for group C, it was 83% (P = 0.03). Among patients with single stones of 21 to 30 mm, the rate of fragment clearance for group A was 63%; for group B, it was 32%; and for group C, it was 58% (P less than 0.005). Among patients with two or three stones, the rate of fragment clearance for group A was 38%; for group B, it was 16%; and for group C, it was 46% (P = 0.01). Patients with fragments of 3 mm or less 24 hours after lithotripsy was done showed a higher probability of fragment disappearance than did those with larger fragments (P less than 0.001). The clearance rate was higher in patients who were compliant than in those who were noncompliant with bile acid therapy (P less than 0.001). Adverse effects included liver hematoma in 1 patients, biliary pain attacks in 253 patients (36%), mild biliary pancreatitis in 13 patients (2%), and cholestasis in 7 patients (1%). Elective cholecystectomy was done in 16 patients (2%), and endoscopic sphincterotomy was done in 4 patients (1%).
CONCLUSIONS
The rate of complete disappearance of stones after shock wave therapy depends on the size and the number of the initial stones, the diameter of the largest fragment, and the mode of shock wave treatment. Adjuvant therapy with bile acids appears to be important for complete fragment clearance.
胆结石患者静息胆囊体积和餐后排空的超声评估。
DOI：
10.2214/ajr.148.5.875
发表时间：
1987
期刊：
AJR. American journal of roentgenology
影响因子：
--
作者：
Kishk,SM;Darweesh,RM;Dodds,WJ;Lawson,TL;Stewart,ET;Kern,MK;Hassanein,EH
通讯作者：
Hassanein,EH