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Objective To explore the clinical application value of electrohydraulic shock wave lithotripsy combined with laparoscope and choledochoscope in treatment of intra-and extrahepatic cholangiolithiasis.Methods The clinical data of 42 patients with intra-and extrahepatic cholangiolithiasis treated by laparoscope and choledochoscope(control group) in hepatobiliary surgery department of affiliated hospital of Xuzhou medical university from May 2012 to December 2015,and patients with intra-and extrahepatic cholangiolithiasis treated by electrohydraulic shock wave lithotripsy combined with laparoscope and choledochoscope (combined group) from January 2016 to February 2017,were retrospectively analyzed.The rate of transferring to laparotomy (transfer to laparotomy due to inflammatory adhesion or difficulty to remove),residual rate of choledocholithiasis,incidence of bile leakage and incidence of common bile duct stricture between two groups were compared.Results All patients in both groups were recovered.In the control group,there were 6 cases(6/42) transferred to laparotomy,among which 2 cases were transferred to laparotomy due to severe abdominal inflammatory adhesion and 4 cases were due to the difficulty to remove the calculus,without bile leakage or common bile duct stricture.There were 3 cases with residual choledocholithiasis,but without bile leakage or common bile duct stricture.In the combined group,there were 2 cases(2/42) transferred to laparotomy due to severe abdominal inflammatory adhesion and 5 cases used the technique of electrohydraulic shock wave lithotripsy without post-operation residual choledocholithiasis,bile leakage or bile duct stricture.In the control group,the residual choledocholithiasis was removed with T tube fistula choledochoscope.Conclusion In the process of minimally invasive surgery to treat intra-and extrahepatic cholangiolithiasis,electrohydraulic shock wave lithotripsy under laparoscope and choledochoscope can decrease the incidence of transferring to laparotomy due to the difficulty to remove calculus and the residual rate of calculus.It can be applied safely and efficiently to patients with intra-and extrahepatic cholangiolithiasis but with laparoscopic surgery indications.
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Direct peroral cholangioscopy (POC) which permits direct visualization of the biliary tree has recently gained widespread clinical use for diagnosis and treatment of various pancreatobiliary diseases. But, there is currently little reliable data on evaluating the complications of POC. POC is associated with complications such as pancreatitis, cholangitis, hemorrhage, rarely air embolism, and ductal perforation. The incidence of complication during POC is 2.9-12%. However, pneumoperitoneum due to intrahepatic bile duct perforation after POC has not yet been reported in Korea. We report a case of pneumoperitoneum after POC which has been successfully managed with endoscopic nasobiliary drainage and antibiotics.
Subject(s)
Anti-Bacterial Agents , Bile Ducts, Intrahepatic , Biliary Tract , Cholangitis , Diagnosis , Drainage , Embolism, Air , Hemorrhage , Incidence , Korea , Pancreatitis , PneumoperitoneumABSTRACT
Objective To explore the therapeutic strategy and clinical value of intraoperative chole-dochoscopy and electrohydraulic lithotripsy for refractory intrahepatic bile duct stones.Methods Liver pa-renchyma,intrahepatic bile duct and bile duct stones were explored under direct vision and intraoperative choledochoscope in 1 1 cases of refractory intrahepatic bile duct stones.Electrohydraulic lithotripsy and lithot-omy were performed to remove the stones and protect the liver parenchyma.If the stones could not be re-moved once,a secondary lithotripsy and lithotomy was performed through the fistula tract.Results All re-fractory calculi were crushed after one or two procedures and the clearance rate were 100%.No complica-tions occurred.Ten patients were followed up from 1 to 3 years except one.Three cases revealed recurrent stone during follow-up due to withdrawal of ursodeoxycholic acid capsules in 1 to 2 years.Seven others showed no stone recurrence within follow-up time.Conclusion Intraoperative choledochoscopy and electro-hydraulic lithotripsy is an easy technique and can effectively protect the liver parenchyma.The life quality of patients can be improved with low surgical risk and postoperative complications.
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Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial.
Subject(s)
Humans , Middle Aged , Abdominal Pain , Afferent Loop Syndrome , Amylases , Constriction, Pathologic , Endoscopes , Gastrectomy , Gastric Bypass , Lithotripsy , Pancreatic Ducts , PancreatitisABSTRACT
Gastric bezoars are collection of indigestible material in the stomach, and these can be classified into five broad categories: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar and miscellaneous materials such as sand, stone and concrete (gypsum). The treatment of gastric bezoars has recently changed from surgical management to such nonsurgical interventions as enzymatic dissolution, nasogastric suctioning and endoscopic removal by polypectomy snare and basket. Up to the present, electrohydraulic lithotripsy has been a well established method for the treatment of urinary and hepatobiliary stones. We report here on a patient who had a huge gastric bezoar that was formed by the ingestion of gypsum, and this was treated with endoscopic electrohydraulic lithotripsy.
Subject(s)
Humans , Bezoars , Calcium Sulfate , Eating , Endoscopy , Lithotripsy , Silicon Dioxide , SNARE Proteins , Stomach , SuctionABSTRACT
Objective To evaluate the clinical value of choledochoscopy combined with electrohydraulic lithotripsy (EHL) for the treatment of pancreatolithiasis. Methods From October 2002 to July 2006, choledochoscopy combined with EHL was used in 11 patients with pancreatolithiasis during a dissection of the pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis (EHL group). The data of these patients were compared with the data of 12 patients with pancreatolithiasis, who were treated by routine dissection of the pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis from January 1995 to September 2002 (Routine group). Results The intraoperative blood loss and the postoperative rate of residual stones in the EHL group were significantly less than those in the routine group [(145.5?82.0) ml vs (406.7?384.9) ml, t=-2.201, P= 0.039; and 0% vs 41.7%, P= 0.037]. The postoperative rate of pain relief in the EHL group was higher than that in the routine group (90.9% vs 58.3%), however the difference was not significant (P=0.155). In the EHL group, 6 patients had diarrhea before the operation, 4 of them achieved relief after the surgery (4/6), which was not significantly more than that in the routine group (5/9, P=1.000). Before the operation, 7 patients in the EHL group and 9 in the routine group had diabetic mellitus; in each group, the disease was relieved in 2 patients after the operation (2/7 vs 2/9, P=0.665). Conclusions Choledochoscopy combined with EHL is effective for the treatment of pancreatolithiasis. The procedure can increase the rate of stone removal, decrease the intraoperative blood loss, and elevate the postoperative rate of pain relief.
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Choledochoscopic lithotomy with the aid of electrohydraulic lithotripsy ( EHL ) was performed in 12 patients at the Department of Surgery, College of Medicine, the Catholic University of Korea, St. Vincent Hospital between January 1996 and March 1998. This retrospective analysis include 4 patients with common bile duct (CBD) stones, 5 patients with intrahepatic duct (IHD) stones, and 3 patients with CBD & IHD stones. The male to female ratio was 1 to 2. The peak incidence of age was the fifty. As a route for the choledochoscopy, a T-tube tract was used in 9 patients, while percutaneous biliary drainage followed by dilatation of the tract was established in 3 patients. The largest stones measured 22mm (by 5mm), the average is 10.3mm. Average number of session which performed for IHD stones was 3.7, while that of CBD stones was 2.7. Complete removal of the stones was achieved in 7 of 12 patients. Retained stones of CBD were removed completely in all cases. We could not removed retained stones completely in cases of multiple, impacted stones in peripheral ducts, associated stricture and acute angulation of IHD & CHD which choledochoscopic manipulation make difficult. Minor complications were bleeding from the bile duct mucosa in 1 patient and postprocedure chills and fever in 1 patient. In conclusion, choledochoscopic lithotomy with electrohydraulic lithotripsy is efficient and will be useful to remove biliary calculi in patients who have poor surgical risks.
Subject(s)
Female , Humans , Male , Bile Ducts , Bile , Chills , Common Bile Duct , Constriction, Pathologic , Dilatation , Drainage , Fever , Gallstones , Hemorrhage , Incidence , Korea , Lithotripsy , Mucous Membrane , Retrospective StudiesABSTRACT
To evaluate the results of transurethral ureteroscopy and electrohydraulic lithotripsy for ureteral calculi needing surgical management. From 1993 to 1995, 101 patients with ureteral calculi were retrospectively analyzed. The locations and sizes of the calculi were examined and the success rate of the procedure was assessed. The overall success rate was 74%. The success rates of upper and lower ureteral calculi were 67% and 81%, respectively. The stone size did not affect the success rates. Among the failure patients, there were no serious complications and they could be subsequently treated with either ureterolithotomy or double J stent replacement. The median hospitalization was 4 days. Transurethral ureteroscopy and electrohydraulic lithotripsy is an effective and safe procedure for ureteral calculi treatment. This method is a minimally invasive procedure and involves a short hospital stay.
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PURPOSE: Four techniques of intracorporeal lithotripsy are now available: ultrasonic, electrohydraulic, laser and Lithoclast. Among these methods, we studied retrospectively the efficacy and safety of Lithoclast and electrohydraulic lithotripsy(EHL) in the treatment of ureteral stones. MATERIALS AND METHODS: From May 1994 to October 1997, a total of 70 cases with ureteral stones were randomized to either method(39 to Lithoclast and 31 to electrohydraulic lithotripsy). RESULTS: Overall success rates were 84.6%(33 cases among 39cases) for Lithoclast and 83.9%(26 cases among 31 cases) for EHL, so both methods are equivalent in efficacy. The success rates according to location were 85.7% in proximal ureter, 82.4% in middle ureter, 86.7% in distal ureter for Lithoclast and 78.6%, 90.0%, 85.7% for EHL. The success rates according to size were 90.0% in or =10mm for Lithoclast and 100%, 77.8%, 90.0% for EHL respectively. There were 6 failures with Lithoclast due to upward migration of stone. There were 5 failures with EHL due to upward migration(3 cases), extremely hard consistency(1 case) and poor visual field(1 case). Complications of ureteroscopic stone removal were fever(1 case), ureteral perforation(1 case) with Lithoclast and hematuria(1 case) with EHL, which were treated conservatively. CONCLUSIONS: We have found that efficacy and safety of EHL is as satisfactory as Lithoclast in skilled hands.
Subject(s)
Hand , Lithotripsy , Retrospective Studies , Ultrasonics , Ureter , Ureteral CalculiABSTRACT
Currently many modalities are available for intracorporeal stone fragmentation. Among them electrohydraulic lithotripsy destructs stone by the effects produced when An electric discharges occurs in a liquid medium. Though electrohydraulic lithotripsy fragments all kinds of urinary calculi effectively, the major limitation of electrohydraulic lithotripsy remains the potential for urothelial injury. The objective of the present study is to evaluate the possible acute and long-term tissue effects of this instrument on the rabbit bladder. The tissue effects produced by a electrohydraulic lithotripsy were examined and compared. In all acute animals, visible mucosal lesions were seen at the site of probe firing in the bladder except the minor of 3millimeter-distance group. No significant long-term tissue effects were noted either grossly or pathologically in the 3-week animals. This study confirms our clinical impression that electrohydraulic lithotripsy can provide an efficient and safe modality of intracorporeal lithotripsy through proper patient selection and careful attention to technique.