Xu Zhi, Wang Li-Xin, Zhang Neng-Wei, Hou Chun-Sheng, Ling Xiao-Feng, Xu Yao, Zhou Xiao-Si
Department of Surgery, Third Hospital of Peking University, 49 North Garden Road, Haidian District, Beijing 100083, China.
World J Gastroenterol. 2006 Jan 7;12(1):130-3. doi: 10.3748/wjg.v12.i1.130.
To verify the safety and efficacy of plasma shock wave lithotripsy (PSWL) in fragmenting impacted stones in the bile duct system.
From September 1988 to April 2005, 67 patients (26 men and 41 women) with impacted stones underwent various biliary operations with tube (or T-tube) drainage. Remnant and impacted stones in the bile duct system found by cholangiography after the operation were fragmented by PSWL and choledochofiberscopy. A total of 201 impacted stones were fragmented by PSWL setting the voltage at 2.5-3.5 kV, and the energy output at 2-3 J for each pulse of PSWL. Then the fragmented stones were extracted by choledochofiberscopy. The safety and efficacy of PSWL were observed during and after the procedure.
One hundred and ninety-nine of 201 impacted stones (99.0%) in the bile duct system were successfully fragmented using PSWL and extracted by choledochofiberscopy. The stone clearance rate for patients was 97% (65/67). Ten patients felt mild pain in the right upper quadrant of the abdomen, and could tolerate it well. Eleven patients had a small amount of bleeding from the mucosa of the bile duct. The bleeding was transient and stopped spontaneously within 2 min of normal saline irrigation. There were no significant complications during and after the procedure.
PSWL is a safe and effective method for fragmenting impacted stones in the bile duct system.
验证等离子体冲击波碎石术（PSWL）在击碎胆管系统嵌顿结石方面的安全性和有效性。
1988年9月至2005年4月，67例患有嵌顿结石的患者（26例男性和41例女性）接受了各种带管（或T管）引流的胆道手术。术后经胆管造影发现的胆管系统内残留及嵌顿结石，通过PSWL和纤维胆道镜进行碎石。通过将PSWL的电压设置为2.5 - 3.5 kV，每次脉冲的能量输出设置为2 - 3 J，共对201颗嵌顿结石进行了PSWL碎石。然后通过纤维胆道镜取出碎石。在手术过程中和术后观察PSWL的安全性和有效性。
胆管系统内201颗嵌顿结石中的199颗（99.0%）成功通过PSWL碎石并经纤维胆道镜取出。患者的结石清除率为97%（65/67）。10例患者右上腹感到轻度疼痛，但能很好地耐受。11例患者胆管黏膜有少量出血。出血是短暂的，在生理盐水冲洗2分钟内自行停止。手术过程中和术后均无明显并发症。
PSWL是一种安全有效的击碎胆管系统嵌顿结石的方法。
