LASER LITHOTRIPSY OF DIFFICULT BILE-DUCT STONES BY MEANS OF A RHODAMINE-6G LASER AND AN INTEGRATED AUTOMATIC STONE-TISSUE DETECTION SYSTEM

被引:56
作者
ELL, C
HOCHBERGER, J
MAY, A
FLEIG, WE
BAUER, R
MENDEZ, L
HAHN, EG
机构
[1] Department of Medicine I, Friedrich-Alexander-University, Erlangen
关键词
D O I
10.1016/S0016-5107(93)70259-X
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
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页码:755 / 762
页数:8
相关论文
共 17 条
[1]   COMMON BILE-DUCT LASER LITHOTRIPSY [J].
BERCI, G ;
HAMLIN, JA ;
DAYKHOVSKY, L ;
PAZPARTLOW, M .
GASTROINTESTINAL ENDOSCOPY, 1990, 36 (02) :137-138
[2]   GIANT BILE-DUCT STONES - NON-SURGICAL TREATMENT [J].
CLASSEN, M ;
HAGENMULLER, F ;
KNYRIM, K ;
FRIMBERGER, E .
ENDOSCOPY, 1988, 20 (01) :21-26
[3]   ENDOSCOPIC LASER LITHOTRIPSY OF LARGE BILE-DUCT STONES [J].
COTTON, PB ;
KOZAREK, RA ;
SCHAPIRO, RH ;
NISHIOKA, NS ;
KELSEY, PB ;
BALL, TJ ;
PUTNAM, WS ;
BARKUN, A ;
WEINERTH, J .
GASTROENTEROLOGY, 1990, 99 (04) :1128-1133
[4]   TREATMENT OF BILE-DUCT STONES BY LASER LITHOTRIPSY - RESULTS IN 12 PATIENTS [J].
DAWSON, SL ;
MUELLER, PR ;
LEE, MJ ;
SAINI, S ;
KELSEY, P ;
NISHIOKA, NS .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1992, 158 (05) :1007-1009
[5]   LASERLITHOTRIPSY OF COMMON BILE-DUCT STONES [J].
ELL, C ;
LUX, G ;
HOCHBERGER, J ;
MULLER, D ;
DEMLING, L .
GUT, 1988, 29 (06) :746-751
[6]   LASER LITHOTRIPSY OF GALLSTONE BY MEANS OF A PULSED NEODYMIUM-YAG LASER - INVITRO AND ANIMAL-EXPERIMENTS [J].
ELL, C ;
HOCHBERGER, J ;
MULLER, D ;
ZIRNGIBL, H ;
GIEDL, J ;
LUX, G ;
DEMLING, L .
ENDOSCOPY, 1986, 18 (03) :92-94
[7]  
ELL C, 1988, IN VITRO TIEREXPERIM
[8]  
ENGELHARDT R, 1988, SOC PHOTOOPTICAL INS, P906
[9]  
GAGNON P, 1991, EFFECTS PULSED DYE L, pA1542
[10]   LITHOTRIPSY OF GALLSTONES BY MEANS OF A QUALITY-SWITCHED GIANT-PULSE NEODYMIUM-YTTRIUM-ALUMINUM-GARNET LASER - BASIC INVITRO STUDIES USING A HIGHLY FLEXIBLE FIBER SYSTEM [J].
HOCHBERGER, J ;
GRUBER, E ;
WIRTZ, P ;
DURR, U ;
KOLB, A ;
ZANGER, U ;
HAHN, EG ;
ELL, C .
GASTROENTEROLOGY, 1991, 101 (05) :1391-1398