Résumé
In this work, the role of the Q-switched and continuous wave [CW] Nd:YAG laser biliary lithotripsy was studied. A total of 120 biliary stones was randomly divided into two groups [A and B], which were conducted to CW and Q-switched Nd:YAG laser, respectively. A radiological and spectroscopic examination was done. Gall bladder wall exposure to both laser techniques was done, then was subjected to gross and microscopic examination. During Q-switched technique at the same volume of cholesterol stones, the fragmenting pulse number was inversely proportionate to the spectroscopic calcium [Ca%] content of the stones. Moreover, the thermal effect of both techniques on the gall bladder wall was evaluated. It can be concluded that CW has a hazardous thermal effect on the soft tissue surroundings which limits its use in biliary lithotripsy. The Q-switched Nd:YAG laser is an effective and safe method for biliary lithotripsy. The fragmenting pulse number depends on the pigment content of the stones. In cholesterol stones, the fragmentation pulse number is inversely proportionate to the Ca content of the stone
Sujets)
Humains , Mâle , Femelle , Lithiase biliaire , Calculs/analyse , Calcium , Cholestérol , Radiologie , Spectrophotométrie atomiqueRésumé
Los procedimientos no quirúrgicos intentan desplazar a la colecistectomía como tratamiento para la litiasis vesicular; son técnicas que se basan en la disolución de litos predominantemente colesterínicos con disolventes químicos o su fragmentación con ondas de choque. Por lo tanto resulta imprescindible conocer el contenido de colesterol de los mismos previo al tratamiento. Se estudiaron in vitro con radiología simple, ecografía, tomografía axial computarizada y resonancia nuclear magnética 10 cálculos vesiculares. Posteriormente se realizó el estudio bioquímico de los mismos. La radiología convencional como la ecografía no permitió conocer la estructura interna de los litos. Los partones hipertenso, hipointenso y heterogéneo, confeccionados con resonancia nuclear, mostraron un pobre correlato con el contenio químico de los cálculos. Se elaboraron los patrones tomográficos hipodenso, isodenso, heterogéneo, anular e hiperdenso, demostrando un íntimo correlato entre el contenido de colesterol y la imagen de los patrones hipodenso e isodenso.