THE COMBINED USE OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY AND DISSOLVING AGENT MTBE FOR COMMON BILE DUCT

In the treatment of common bile duct stones, both extracorporeal shockwave lithotripsy (ESWL) and direct method using some dissolvent like MTBE have respective problem; namely, ESWL demands drainage of fragments of gallstones and the other dose repeated injection and drawing of MTBE to get good contact with gallstones. The purpose of this study is to determine whether the combine use of the both methods could offer two effects simultaneously, that is an effect dissolving the gallstone fragments by a dissolvent like MTBE and another effect mixing MTBE by shockwave.An in vitro experiment of the combine use was conducted by using cholesterol mixed stones. It was found cholesterol dissolved into the MTBE as oil molecules and the fragments of the mixed stones were easily reduced.According to this study, the combine therapy of ESWL and MTBE was performed in two patient who had common bile duct stones. complete dissolution of cholesterol stones was obtained in one, but another one who had biliribinate stones necessitated EST. Although, in the case of bilirubin stones, some dissolving agent, other than MTBE should be employed, this combined use of ESWL and dissolving agent would be recommended for common bile duct stones.