ピエゾ効果方式衝撃波破砕療法―胆囊胆石に対する有効性と安全性の検討

Piezo-Electric Shock-Wave Lithotripsy of Gallbladder Stones: A Clinical Evaluation of Its Efficacy and Safety

要旨　ピエゾ効果方式装置（EDAP LT-01）を用いて胆囊胆石73症例を対象に体外衝撃波療法を行い，有効性と安全性について検討した結果，次の成績を得た．①胆石数1個，径30mm以下でX線透過性，Ⅰ型エコーパターンを示す胆石群の破砕率は100％，完全消失率は53％であり，この胆石群は良い適応と考えられた．②石灰化胆石群の破砕率は62％，完全消失率は25％であり，胆石の選別を行うことで適応となりうることが判明した．③とう痛対策を必要とせず，外来通院で，繰り返し治療が簡便に行えた．④完全消失23例のうち74％（胆汁酸服用4例，非服用13例）は2か月以内の早期に消失した．これは，早期消失に関する胆汁酸溶解療法の併用の意義は少ないと考えられると共に繰り返し治療により胆石の一層の細片化が行えるピエゾ効果方式ESWLの特徴に基づくものと考えられた．⑤衝撃波照射による臓器への影響は軽微かつ低頻度であり，安全性は高いと考えられた．

　Extrcorporeal shock-wave lithotripsy (ESWL) using the EDAP LT-01 piezo-electric lithotriptor was performed in 73 patients with gallbladder stones. Bile acid was not administered as adjuvant litholytic therapy, as a rule. Our results concerning its clinical effectiveness and safety are as follows:

　1) In the group with single radiolucent ― Type Ⅰ (sonographic pattern) stones with a diameter of up to 30 mm, the stones were disintegrated in all patients (n=36) and completely disappeared in 53 percent (n=19). This group was a good candidate for ESWL.

　2) The calcified stones (n=13) were disintegrated in 62 percent (n=8) of the patients with 2-4 Type Ⅱ or Ⅲ stones with a diameter of up to 20 mm, and completely disappeared in 25 percent (n=2). ESWL seems to be an effective treatment in selected patients even with calcified stones.

　3) The piezo-electric ESWL was performed simply and repeatedly with no anesthesia nor analgesia on an ambulatory basis.

　4) Out of 23 patients whose stones completely disappeared, 74 percent (n=17: UDCA administration, n=4; no adjuvant therapy, n=13)

　had a stone-free gallbladder within two months after completion of the repeated ESWL treatment. Stone dissolution therapy may not be significantly effective for obtaining stone clearance in a very short period.

　5) The degree of adverse effects, produced by shock-wave discharge, for the skin, chest and abdominal organs was negligible and the rate was low.

　In conclusion, we consider the piezo-electric ESWL a useful and safe method for the treatment of gallbladder stones.