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Current status of chemolitholysis

Derzeitiger Stand der Auflösung von Gallenblasen-und Gallengangssteinen

  • Original Scientific Reports
  • Die aktuelle Diskussion Behandlung der Cholezystolithiasis
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Abstract

Oral litholysis is indicated for patients with gallbladder stones not exceeding 1.5 cm in diameter. Chenodeoxycholic acid and ursodeoxycholic acid are safe, the therapy is not more expensive than surgery and has a success rate of 60 to 70%. Extracorporeal shock-wave lithotripsy in combination with oral litholysis is indicated for patients with solitary stones of 2 cm in diameter. Side effects are minimal, success rate 90% after 12 months therapy. Methyl tert-butyl ether for direct contact litholysis after gallbladder puncture is suitable for all stone numbers and stone sizes in low and high risk patients. Mean treatment time is 9 hours, dissolution rate 95%. Only few side effects have been reported. Solvents for intra-and extrahepatic pigment stones are available, but toxicity investigations are still lacking.

Disadvantages of chemolitholysis are a success rate of less than 100%, long treatment times and stone recurrence. The annual recurrence rate is 10% through 4 to 5 years. Postdissolution therapy cannot prevent but only reduce the recurrence rate. Oral litholysis is without therapy-related side effects and without a lethality, it will always have a place in gallstone therapy. For rating shock-wave lithotripsy and contact litholysis we need more data. Since chemolitholysis of intrahepatic pigment stones in many patients is the only or at least safest therapy, it will have a place in the future.

Zusammenfassung

Die orale Litholyse ist für Patienten mit Gallenblasensteinen angezeigt, die nicht größer als 1,5 cm im Durchmesser sind. Chenodesoxycholsäure und Ursodesoxycholsäure stellen eine sichere Behandlung dar, die Therapie ist nicht teurer als die Operation und hat eine Erfolgsrate von 60 bis 70%. Die extrakorporale Schockwellenlithotripsie in Verbindung mit oraler Litholyse ist für Patienten mit Solitärsteinen mit einem maximalen Durchmesser von 2 cm indiziert. Nebenwirkungen sind sehr selten, die Erfolgsrate liegt nach 12monatiger Nachbehandlung bei 90%. Die direkte Kontaktlitholyse mit Methyl-tert-Butyl-Äther nach Gallenblasenpunktion ist für jede Steinzahl und— größe geeignet, besonders für Patienten mit hohem Operationsrisiko. Die durchschnittliche Behandlungszeit beträgt 9 Stunden, die Auflösungsrate 95%. Nebenwirkungen sind selten. Lösungsmittel für intra-und extrahepatische Pigmentsteine sind wirkungsvoll, doch liegen zur Zeit noch keine Toxizitätsuntersuchungen vor.

Die Nachteile der Chemolitholyse sind eine Erfolgsrate unter 100%, die langen Behandlungszeiten und die Möglichkeit der Rezidivsteinentwicklung. Die jährliche Rezidivrate beträgt 10% über 4 bis 5 Jahre. Die Nachbehandlung nach Steinauflösung kann Rezidive nicht verhindern, sondern nur die Häufigkeit reduzieren. Die orale Litholyse hat keine therapiebezogenen Nebenwirkungen und besitzt keine Letalität, weswegen sie immer einen Platz bei der Gallensteinbehandlung haben wird. Um die Schockwellenlithotripsie und die Kontaktlitholyse einschätzen zu können, werden weitere Daten benötigt. Da die Chemolitholyse von intrahepatischen Pigmentsteinen für viele Patienten das einzige Therapieverfahren darstellt, wird sie auch in Zukunft einen Platz in der Behandlung des Gallensteinleidens haben.

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  1. Center of Internal Medicine, Jahann Wolfgang Wolfgang Goethe University, Theodor-Stern-Kai 7, D-W-6000, Frankfurt/Main, Germany

    U. Leuschner M.D.

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Leuschner, U. Current status of chemolitholysis. Acta Chir Austriaca 24, 245–250 (1992). https://doi.org/10.1007/BF02601757

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