Ell C, Hochberger J, May A, Fleig W E, Bauer R, Mendez L, Hahn E G
Department of Medicine I, Friedrich-Alexander-University, Erlangen, Germany.
Gastrointest Endosc. 1993 Nov-Dec;39(6):755-62. doi: 10.1016/s0016-5107(93)70259-x.
This report describes the initial clinical implementation of a new laser lithotripter system capable of effective fragmentation of common bile duct stones with a high degree of safety provided by an integrated stone-tissue detection system. This system automatically terminates laser pulse transmission if tissue contact is sensed. Eighteen patients with giant or impacted common bile duct stones refractory to standard treatment techniques were treated via the endoscopic retrograde route using a rhodamine-6G dye laser with an integrated stone-tissue detection system. In the event of tissue contact, the stone-tissue detection system cuts off the laser pulse after 190 ns (after transmission of 5% to 8% of the total pulse energy). Nine patients were treated under cholangioscopic control, and nine patients were treated blindly under fluoroscopic control using only standard duodenoscopes with either a 6F standard endoscopic retrograde cholangiopancreatography catheter (4 patients), a 6.8F balloon catheter (3 patients), or a laser lithotriptor basket (2 patients). Laser-induced fragmentation was achieved in all 18 patients (100%). Sixteen of 18 patients (89%) became completely stone-free after completion of the treatment, including additional intracorporeal shock wave lithotripsy in five patients. The only major complications occurred in one fully anticoagulated patient with a prosthetic heart valve who developed significant hemobilia and transient cholangitis but recovered after conservative treatment. Laser lithotripsy using the rhodamine-6G dye laser plus stone-tissue detection system appears safe and effective and allows "blind" fragmentation of difficult common bile duct stones to be performed under radiologic control.
本报告描述了一种新型激光碎石系统的首次临床应用，该系统能够有效破碎胆总管结石，并由集成的结石-组织检测系统提供高度安全性。如果检测到组织接触，该系统会自动终止激光脉冲传输。18例经标准治疗技术难以处理的巨大或嵌顿性胆总管结石患者，通过内镜逆行途径，使用带有集成结石-组织检测系统的若丹明-6G染料激光进行治疗。一旦发生组织接触，结石-组织检测系统会在190纳秒后（在总脉冲能量的5%至8%传输后）切断激光脉冲。9例患者在胆管镜控制下接受治疗，9例患者仅使用标准十二指肠镜在荧光透视控制下盲目治疗，分别使用6F标准内镜逆行胰胆管造影导管（4例）、6.8F球囊导管（3例）或激光碎石篮（2例）。所有18例患者（100%）均实现了激光诱导破碎。18例患者中有16例（89%）在治疗完成后结石完全清除，其中5例患者还接受了额外的体内冲击波碎石术。唯一的主要并发症发生在1例装有人工心脏瓣膜且完全抗凝的患者身上，该患者出现了严重的胆道出血和短暂性胆管炎，但经保守治疗后康复。使用若丹明-6G染料激光加结石-组织检测系统进行激光碎石术似乎安全有效，并且能够在放射学控制下对困难的胆总管结石进行“盲目”破碎。
