[Biliary extracorporeal shockwave lithotripsy in the surgical treatment concept of cholelithiasis].
Extracorporeal shock-wave lithotripsy (BESWL) using the "Obertisch" module Lithostar Plus (Siemens AG) was carried out in 100 patients, comprising a total of 189 gallbladder stones with a size range from 8 to 35 mm. Chenodeoxycholic and ursodeoxycholic acid was given as adjuvant litholytic therapy, beginning 14 days before treatment. 53% of the patients suffered from radiolucent solitary stones with an average size of 21 +/- 6 mm. 14% had more than 3 stones, another 12% had solitary stones with a small rim calcification. In 99 patients all stones could be disintegrated. In 90% we achieved a fragment size smaller than 5 mm, in 10% smaller than 8 mm. 68 patients were treated in a single session, in 32% a 2nd or 3rd treatment was necessary. In the average 4100 +/- 2200 shock-waves with energy level 9 (650 bar) were applied. During treatment 15 patients suffered from slight right kidney pain. In the following 48 hours after BESWL we observed a transitory significant elevation of transaminases (32%), urinary amylases without clinical symptoms (31%), bilirubin (31%) and white blood cells (71%). A microhematuria was seen in 33%, a macrohematuria in 2%. Post-BESWL sonographically we found a transitory edema of the gallbladder wall in 18%, in 15% a hydrops, in 10% a dilatation of the common bile duct and in 4% free fluid surrounding the gallbladder. After dismission 31% of the patients suffered from slight colicky pain. In 3 patients acute biliary pancreatitis was observed 4 and 8 weeks after BESWL which could be treated by EPT and endoscopic stone removal.
Meiser
G
G
I. Chirurgische Abteilung und Ludwig-Boltzmann-Institut für experimentelle und gastroenterologische Chirurgie, Landeskrankenanstalten Salzburg.
Heinerman
M
M
Boeckl
O
O
D000328:Adult; D000368:Aged; D002635:Chenodeoxycholic Acid / Q000008:administration & dosage; D002769:Cholelithiasis / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage
D002635:Chenodeoxycholic Acid; D014580:Ursodeoxycholic Acid
Biliäre extracorporale Stosswellenlithotripsie (BESWL) im chirurgischen Therapiekonzept der Cholelithiasis.