Lingenfelser T, Routschka A, Grossmann T, Dette S, Distler A, Renn W
Department of Medicine, Eberhard-Karls-University Tuebingen, Germany.
J Stone Dis. 1993 Apr;5(2):118-24.
Intracorporal lithotripsy has gathered momentum in the management of gallstone disease due to the increasing sophistication of technical equipment for the percutaneous, as well as the retrograde-endoscopic route. Laser-induced shock wave lithotripsy (LISL) and electrohydraulic lithotripsy (EHL) have proved feasible by allowing reliable fragmentation of biliary calculi. Evaluation of therapeutic risks, e.g., effects of accidental irradiation of the gallbladder wall, has been performed in small sample sizes only. We investigated the effects of LISL and EHL on multiple sets of human and porcine gallbladders under in vitro conditions. Gallbladders were freshly harvested, mounted, and immersed in different mediums (normal saline, blood, bile). They were swiftly exposed to LISL (Pulsolith¿) and EHL (Lithotron EL 23¿) under differing experimental conditions (energy setting, pulse mode, exposition time, medium, probe pressure) and subjected to standard procedures for morphometric evaluation (Bioquant¿). Tissue effects were described by the depth (d) and width (w) of the cratered lesions, as well as the extension of the damage in the surrounding tissue(s). Serial cuts of the exposed areas yielded 894 section for morphometric analysis. Multivariate analysis of variance (MANOVA) revealed a significant effect of laser energy (p[d] less than 0.002, p[w] < 0.05, p[s] < 0.05), medium (p[d] less than 0.03, p[w] < 0.001, p[s] < 0.04, and exposition time (p[d] less than 0.001, p[s] < 0.001) on the degree of tissue lesion.(ABSTRACT TRUNCATED AT 250 WORDS)
由于经皮和逆行内镜技术设备日益精密，体内碎石术在胆结石疾病的治疗中得到了更多应用。激光诱导冲击波碎石术（LISL）和液电碎石术（EHL）已被证明可有效破碎胆管结石。不过，仅在小样本中对治疗风险进行了评估，例如意外照射胆囊壁的影响。我们在体外条件下研究了LISL和EHL对多组人及猪胆囊的影响。胆囊新鲜摘取、安装并浸入不同介质（生理盐水、血液、胆汁）中。在不同实验条件（能量设置、脉冲模式、照射时间、介质、探头压力）下，它们被迅速暴露于LISL（Pulsolith®）和EHL（Lithotron EL 23®）下，并接受形态计量学评估的标准程序（Bioquant®）。通过凹陷性病变的深度（d）和宽度（w）以及周围组织损伤的范围来描述组织效应。暴露区域的连续切片产生了894个切片用于形态计量分析。多变量方差分析（MANOVA）显示激光能量（p[d]小于0.002，p[w]<0.05，p[s]<0.05）、介质（p[d]小于0.03，p[w]<0.001，p[s]<0.04）和照射时间（p[d]小于0.001，p[s]<0.001）对组织损伤程度有显著影响。（摘要截短于250字）
