Jakobs R, Pereira-Lima J C, Maier M, Kohler B, Benz C, Adamek H E, Riemann J F
Hospital de Clínicas de Ludwigshafen, Alemanha.
Arq Gastroenterol. 1996 Jul-Sep;33(3):145-50.
More than 97% of common bile duct stones can be successfully managed by endoscopic papillotomy, mechanical lithotripsy and extracorporeal shock-wave lithotripsy. In this study, we evaluate the role of laser lithotripsy after failure of the above mentioned endoscopic methods.
Eighteen patients (15F, 3M; median age = 69 (28-83) years) were treated by endoscopic laser lithotripsy after ESWL failure. We employed a Rhodamine-6 G laser with a stone-tissue recognizing system. The laser fibers were cholangioscopically (direct vision) or blindly (under plain fluoroscopic control) placed.
Seventeen patients were treated endoscopically and one was successfully managed percutaneously after failure of the transpapillary approach. Fourteen (78%) were stone-free after a mean of 1.56 laser therapy sessions alone. Two additional patients were successfully managed after partial fragmentation with combined treatment (mechanical lithotripsy: n = 1, electrohydraulic lithotripsy: n = 1). Overall, 89% of the patients were freed from their calculi. Cholangitis occurred once and the mortality was zero.
We conclude that laser lithotripsy is an effective and safe treatment alternative in a highly selected patient population with difficult bile duct stones and considerable surgical risk.
超过97%的胆总管结石可通过内镜乳头切开术、机械碎石术和体外冲击波碎石术成功治疗。在本研究中，我们评估了上述内镜方法失败后激光碎石术的作用。
18例患者（15例女性，3例男性；中位年龄 = 69（28 - 83）岁）在体外冲击波碎石术失败后接受了内镜激光碎石术治疗。我们使用了带有结石组织识别系统的罗丹明-6G激光。激光纤维通过胆管镜（直视）或盲目（在普通荧光透视控制下）放置。
17例患者接受了内镜治疗，1例在经乳头途径失败后通过经皮途径成功治疗。仅平均经过1.56次激光治疗后，14例（78%）患者结石清除。另外2例患者在联合治疗（机械碎石术：1例，电液压碎石术：1例）部分碎石后成功治疗。总体而言，89%的患者结石清除。发生胆管炎1次，死亡率为零。
我们得出结论，对于高度选择的患有复杂胆管结石且手术风险较大的患者群体，激光碎石术是一种有效且安全的治疗选择。
