Chang B W, Pollock M E, Eugene J, Berns M W, Mason G R
Department of Surgery, University of California, Irvine 92668.
J Invest Surg. 1991;4(4):467-76. doi: 10.3109/08941939109141177.
This study evaluates the pulsed tunable dye laser with wavelength 504 nm, frequency 10 Hz, and pulse width 1.2 microseconds for cholelitholysis. Power of 10-40 kW was directed through a 250-microns quartz fiber optic to ablate 55 gallstones (removed from 14 patients). The fiber was positioned in direct contact with the stones under saline. Power delivery was begun at 10 kW and increased in 10-kW increments until litholysis began. The range of power and energy necessary to fragment the gallstones was evaluated on four common bile ducts (fresh autopsy specimens). Following fragmentation, all stones were analyzed. There were 35 cholesterol stones (3 calcified) and 20 bilirubin stones (4 calcified). Size ranged from 0.012 to 7.56 cm3 (mean 0.96 +/- 1.41 cm3). Energy necessary for fragmentation ranged from 0.4 to 11.2 J (exposure time 1.0-28 s). Power necessary for fragmentation was 20 kW for 2/55 stones and 40 kW for 53/55 stones. At 40 kW (40 mJ/pulse), common bile duct perforation occurred within 1.1 +/- 0.1 s (0.44 +/- 0.04 J). The pulsed tunable dye laser can fragment gallstones of all compositions. The threshold for fragmentation is 40 kW, but common bile duct perforation occurs at this power. We conclude that laser radiation sufficient to fragment gallstones can injure the common bile duct.
本研究评估了波长504nm、频率10Hz、脉宽1.2微秒的脉冲可调染料激光用于胆石溶解的效果。10 - 40kW的功率通过一根250微米的石英光纤传导，以消融55颗胆结石（取自14例患者）。光纤在生理盐水下直接与结石接触放置。功率输送从10kW开始，以10kW的增量增加，直至开始结石溶解。在四条胆总管（新鲜尸检标本）上评估破碎胆结石所需的功率和能量范围。破碎后，对所有结石进行分析。有35颗胆固醇结石（3颗钙化）和20颗胆红素结石（4颗钙化）。大小范围为0.012至7.56cm³（平均0.96±1.41cm³）。破碎所需的能量范围为0.4至11.2J（暴露时间1.0 - 28s）。55颗结石中有2颗破碎所需功率为20kW，53颗为40kW。在40kW（40mJ/脉冲）时，胆总管穿孔在1.1±0.1s（0.44±0.04J）内发生。脉冲可调染料激光可破碎所有成分的胆结石。破碎阈值为40kW，但在此功率下会发生胆总管穿孔。我们得出结论，足以破碎胆结石的激光辐射会损伤胆总管。
