Carroll B, Chandra M, Papaioannou T, Daykhovsky L, Grundfest W, Phillips E
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Surg Endosc. 1993 Jul-Aug;7(4):356-9. doi: 10.1007/BF00725957.
We investigated various energy sources and delivery systems suitable for fragmentation of common duct calculi by a laparoscopic technique. We evaluated electrohydraulic lithotripsy (EHL) using 1.9-Fr probe delivering 80 W and laser lithotripsy using a 200-micron(s) fiber delivering 30-70 mJ/pulse at 5-20 Hz. In vitro biliary stone fragmentation analysis suggested that the laser lithotripsy produced a more controllable fragmentation than EHL. Initial attempts to employ EHL techniques in animal models resulted in common bile duct injury or inadequate fragmentation of stones. In contrast, biliary lithotripsy was accomplished in pigs using the pulsed-dye laser at 10 Hz and 60 mJ/pulse. Histologic evaluation revealed no evidence of ductal injury related to laser stone fragmentation. Subsequently, laser common duct lithotripsy was used in two human subjects. One patient had a 1.8-cm impacted ampullary stone and one patient had a 3-cm intrahepatic stone. In both cases, the stones were removed laparoscopically after laser fragmentation. Our experience suggests that the laser lithotripsy may facilitate laparoscopic common duct stone extraction procedures.
我们研究了各种适用于通过腹腔镜技术破碎胆总管结石的能量源和输送系统。我们评估了使用输送80W功率的1.9F探头的电液压碎石术（EHL）以及使用在5-20Hz频率下输送30-70mJ/脉冲能量的200微米光纤的激光碎石术。体外胆管结石破碎分析表明，激光碎石术比EHL产生的结石破碎更可控。在动物模型中最初尝试采用EHL技术导致胆总管损伤或结石破碎不充分。相比之下，在猪身上使用脉冲染料激光以10Hz频率和60mJ/脉冲能量完成了胆管碎石术。组织学评估显示没有与激光碎石相关的导管损伤证据。随后，激光胆总管碎石术应用于两名人类受试者。一名患者有一枚1.8cm的壶腹嵌顿结石，另一名患者有一枚3cm的肝内结石。在这两个病例中，结石在激光破碎后通过腹腔镜取出。我们的经验表明，激光碎石术可能有助于腹腔镜胆总管结石取出手术。
