[Improvement of extracorporeal shockwave cholelithotripsy in the comprehensive treatment of cholelithiasis]

The method of shockwave distant lithotripsy (DL) has been used since 1985. However, many facets of this problem have not been solved yet, because large fragments of the stone remain after its destruction, and focused shock waves (FSW) damage the gallbladder (GB). The aim of this study was to determine possibilities of effective distant destruction of gall stones, to reveal negative consequences of the effects of FSW on the gallbladder (GB) and the surrounding tissues, as well as development and perfection of DL technique. The established parameters of FSW were used to develop the new Lithotriptor Compact. By now, 53 patients with cholelithiasis aged 18 to 55 have been treated by DC. The procedure was performed without general anesthesia. A thousand to 3500 shockwave impulses were applied to each stone. All patients had received litholytic therapy and treatment directed towards metabolic normalization, the functional state of the GB, and prevention of recurrent stone formation, prior to DL. In total, 116 DL sessions (2.2 sessions per a patient) were performed. A positive effect as a result of the complex treatment of cholelithiasis using DL method was achieved in 47 (88.7%) of the patients. There were no complications. In 3 patients (5.7%) recurrence of gallstones was found two years after DL sessions. Correctly selected parameters of FSW and DL technology allow for effective destruction of GB stones, while conservative therapy favors their passage through the biliary tract and fast litholysis of remaining stone fragments.