以體外震波碎石術輔助治療再發性總膽管結石

Extracorporeal Shock Wave Lithotripsy in the Treatment of Recurrent Common Bile Duct Stone

黃志仁(Chi-Ren Huang) ； 葉大成(Ta-Chung Yei) ； 楊美都(Mei-Du Yang) ； 吳誠中(Chen-Chun Wu) ； 劉自嘉(Tse-Jla Liu) ； 劉振華(Chen-Hwa Liu)

《中華民國消化系醫學會雜誌》 10卷1期 (1993/03) Pp. 9-14

https://doi.org/10.6557/GJTa.199303_10(1).0002

摘要

再發性總瞻管結石以內視鏡取石失敗者，須以較侵犯性的外科手術治療。利用體外震波碎石術擊碎膽管結石後，再以內視鏡取出碎結石，可增加內視鏡取石成功率，減少病患接受重複手術的必要性。自78年10月起，我們選擇23位有再發性總膽管結石的患者，經內視鏡取石失敗後接受體外震波碎石治療。結果發現17位患者(73.9%)總膽管結石可由體外震波碎石機予以擊碎，而由內視鏡順利取出碎結石，因此，體外震波碎石術可安全，有效的輔助內視鏡治療再發性總膽管結石。

關鍵字

體外震波碎石術 ； 總膽管結石

並列摘要

The Preliminary experience of using extracorporeal shock wave lithotripsy (ESWL) in the management of 23 cholecystectomized patients with recurrent common bile duct stones which could not be extracted by endoscopic lithotripsy is described, and its effectiveness in clinical application is discussed. Using a Siemens Lithostar Plus lithotriptor, fragmentation of the common bile duct stones was done without general anesthesia. In all cases, nasobiliary catheters were established before the procedure in order to allow access for radiographic localization during the procedure and ensure free drainage of infected bile. Fragmentation of the stones was successful in 17 patients (73.9%) by ESWL; and the extraction of the fragmented stones was done by endoscopic lithotripsy, ensuring quick clearance of the bile duct, to prevent recurrence of cholangitis. Failure of fragmentation of common bile duct stone by ESWL occurred in 4 patients (17.3%), who then received celitomy to remove the CBD stones. One patient refused to have further treatment after one session of shock wave treatment, and in one patient the stone was not localized by X-ray fluoroscopy. Morbidity was minimal, and no mortality occurred in our series. ESWL is a safe, effective and valuable adjuvant therapy with endoscopic lithotripsy in the management of patients with recurrent common bile duct stones.

並列關鍵字

Extracorporeal shock wave lithotripsy ； Common bile duct stone