Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland.
Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Lasers Med Sci. 2022 Feb;37(1):163-169. doi: 10.1007/s10103-020-03201-0. Epub 2020 Nov 21.
Incorporeal lithotripsy by using holmium:YAG laser has been recently successfully spread and used in the treatment of urolithiasis. Although this method is not as common in salivary gland surgery, it is also recommended for endoscopic treatment of sialolithiasis. In this study, we decided to analyse effectiveness of holmium:YAG laser method among patients with midsize stones as the treatment in this particular population is still not determined and remains in dispute. Thus, the primary aim of the study is a prospective, complex analysis of incorporeal holmium:YAG laser lithotripsy effectiveness and safety in patients suffering from sialolithiasis. The examined group consisted of 32 consecutive patients, 17 female (53%) and 15 male (47%). The average age was 42 (age range 22-70). In our series, sialoendoscopy with intraductal lithotripsy was performed in patients with wide range of stone's diameter (3 to 10 mm). The calculi were removed with foreign body forceps or retrieval basket, after stone fragmentation with holmium:YAG laser. The power of the laser during surgery was set at 2.5 to 3.5 W. One shot energy equalled 0.5-0.7 J with frequency of 5 Hz. The bivariate Pearson Correlation and a point-biserial correlation were used to analyse the data. Total success rate of holmium:YAG laser lithotripsy in this consecutive group was equal to 90% and efficacy in the group with excluded cases when endoscopic approach difficulties were experienced (stone not visible) reached 93%. The long-term follow-up revealed that in 26 patients (84%), complete recovery was achieved. Two patients developed Wharton's duct stenosis and one Stensen's duct orifice stenosis (9.5%), of whom one required reoperation. Two patients eventually underwent total excision of submandibular gland. Sialoendoscopy combined with incorporeal laser-assisted lithotripsy proved to be effective and safe method for treatment of sialothiasis with midsize stones (4-8 mm) in population of clinic. Even taking into account the prevalence of complications associated with holmium:YAG laser, it is still safer alternative compared to open surgery where there is a significant risk of the bleeding, wound infection or injury of the facial nerve.
YAG 激光进行非接触式碎石术最近已成功应用于治疗尿路结石。尽管这种方法在涎腺手术中并不常见，但也推荐用于内镜治疗涎石症。在这项研究中，我们决定分析钬：YAG 激光方法在中结石患者中的有效性，因为这种特定人群的治疗方法尚未确定，仍存在争议。因此，研究的主要目的是前瞻性、综合分析非接触式钬：YAG 激光碎石术在涎石症患者中的有效性和安全性。检查组包括 32 例连续患者，女性 17 例（53%），男性 15 例（47%）。平均年龄为 42 岁（年龄范围 22-70 岁）。在我们的系列中，对直径范围为 3-10mm 的结石患者进行了涎腺内镜下经导管碎石术。使用异物钳或取石篮取出结石，然后用钬：YAG 激光碎石。手术过程中激光功率设置为 2.5-3.5W。单次能量为 0.5-0.7J，频率为 5Hz。使用双变量 Pearson 相关和点双列相关分析数据。在这组连续患者中，钬：YAG 激光碎石术的总成功率为 90%，当遇到内镜方法困难（结石不可见）时排除病例的疗效达到 93%。长期随访显示，26 例（84%）患者完全康复。2 例发生沃顿管狭窄，1 例发生斯坦纳管口狭窄（9.5%），其中 1 例需要再次手术。2 例患者最终行颌下腺全切除术。涎腺内镜联合非接触式激光辅助碎石术被证明是一种有效且安全的方法，适用于治疗临床人群中 4-8mm 的涎石症。即使考虑到与钬：YAG 激光相关的并发症的流行，与开放性手术相比，它仍然是一种更安全的选择，因为开放性手术存在明显的出血、伤口感染或面神经损伤风险。
