PDF(Pubmed)
Abstract：
Background and Objectives: While studies have demonstrated the efficacy of cholangioscopy-guided Holmium-Yttrium aluminum garnet (Ho:YAG) laser lithotripsy for the treatment of refractory bile duct stones, data regarding the safety of the operating parameters for laser lithotripsy are lacking. The aim of this study was to determine safe, yet effective, energy settings for Ho:YAG laser in the ex-vivo model. Materials and Methods: This ex vivo experimental study utilized the Ho:YAG laser on porcine bile duct epithelium and human gallstones. Ho:YAG laser lithotripsy was applied in different power settings from 8 to 15 Watts (W) to six explanted porcine bile ducts. Settings that appeared safe were then utilized to fragment seventy-three human gallstones. Results: The median bile duct perforation times with the Ho:YAG laser between 8-15 W were: >60 s (8 W); 23 s (9 W); 29 s (10 W); 27 s (12 W); 12 s (14 W); and 8 s (15 W). Statistically significant differences in the median perforation times were noted between 8 W vs. 15 W, 9 W vs. 15 W, 10 W vs. 15 W, and 12 W vs. 15 W (p < 0.05). When using a 365 µm Ho:YAG laser probe at 8-12 W, the fragmentation rates on various size stones were: 100% (<1.5 cm); 80-100% (1.6-2.0 cm) and 0-32% (>2.0 cm). Optimal fragmentation was seen utilizing 12 W with high energy (2.4 J) and low frequency (5 Hz) settings. Using a larger 550 µm probe at these settings resulted in 100% fragmentation of stones larger than 2 cm. Conclusions: The Ho:YAG laser appears to be safe and effective in the treatment of large bile duct stones when used between 8-12 W in 5 s bursts in an ex vivo model utilizing porcine bile ducts and human gallstones.
摘要：
背景和目的：虽然有研究证明了胆道镜引导下钬钇铝石榴石（Ho：YAG）激光碎石术治疗难治性胆管结石的有效性，缺乏有关激光碎石术操作参数安全性的数据。这项研究的目的是确定安全，但有效，Ho：YAG激光在离体模型中的能量设置。材料和方法：这项离体实验研究利用Ho：YAG激光对猪胆管上皮和人胆结石进行了研究。Ho：YAG激光碎石术以8至15瓦（W）的不同功率设置应用于六个移出的猪胆管。然后利用看似安全的环境来破坏73种人胆结石。结果：Ho：YAG激光在8-15W之间的中位胆管穿孔时间为：>60s（8W）；23s（9W）；29s（10W）；27s（12W）；12s（14W）;和8s（15W）。在8W与15W,9Wvs.15W,10Wvs.15W,和12Wvs.15W(p<0.05)。当使用365µmHo:YAG激光探头时，功率为8-12W，不同大小结石的破碎率分别为：100％（<1.5cm）；80-100％（1.6-2.0cm）和0-32％（>2.0cm）。利用具有高能量(2.4J)和低频率(5Hz)设置的12W观察到最佳碎裂。在这些设置下使用较大的550µm探针会导致大于2cm的结石100％碎裂。结论：在使用猪胆管和人胆结石的离体模型中，在5s爆发中在8-12W之间使用Ho：YAG激光治疗大胆管结石似乎是安全有效的。
