거리에 따른 Electrohydraulic Lithotripsy가 토끼방광에 미치는 영향

손형규,장혁준,이경섭,하달봉,배한익 大韓泌尿器科學會 1997 Korean Journal of Urology Vol.38 No.9

Comparison of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy (LithoclastⓇ) Alone or in Combination with Ultrasonic Lithotripsy

조시완,유지형,성락희,정재용,노충희 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.11

Purpose: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for treating large renal stones. Pneumatic lithotripsy (LithoclastⓇ) is effective regardless of the stones’ composition, and ultrasonic lithotripsy allows the aspiration of small debris during lithotripsy. We investigated the efficacy and safety of PCNL via LithoclastⓇ alone or combined with ultrasonic lithotripsy. Materials and Methods: Thirty-five (group A) and 39 (group B) patients underwent LithoclastⓇ PCNL and combination therapy, respectively, from May 2001 to March 2010, and the two groups were compared in terms of stone size, location, and composition; operative time; average number of treatments; hospital days; hemoglobin loss; ancillary procedures; rate of device failure; and initial and total stone-free rates. Results: The two groups did not differ significantly in preoperative stone size, location, or composition; the average number of treatments; or the initial and overall stone-free rates. However, combination therapy was associated with a significantly lower operative time (181±50 vs. 221±65 min, respectively, p=0.004), number of hospital days (11.6±3.8 vs. 14.2±4.4 days, respectively, p=0.009), and average hemoglobin loss (1.12±0.61 vs. 1.39±1.02 g/dl, respectively, p=0.013). Transfusions were required in 6 patients (4 and 2 in each group, respectively), but there were no significant complications related to percutaneous access. There were 2 (5.7%) mechanical failures (LithoclastⓇ probe fracture) in the group A and 5 (12.8%) in the group B (2 cases of suction tube obstruction, 3 cases of overheating). Conclusions: The combination of ultrasonic lithotripter and LithoclastⓇ is more effective than LithoclastⓇ alone because it significantly decreases operative time, hemoglobin loss, and the hospital stay. This may reflect the superior power of LithoclastⓇ and the ability to aspirate the debris during ultrasonic lithotripsy.

Comparison of Sapphire and Germanium Fibers for Erbium : Yag Lithotripsy

Ho Lee,Ji-Wook Yoon,Young-Dae Jung,JeeHyun Kim,Robert T. Ryan,Joel M.H. Teichman,A.J. Welch 한국광학회 2008 Current Optics and Photonics Vol.12 No.4

We studied the sapphire and germanium fibers to determine which optical fiber best transmits Erbium:YAG laser for intracorporeal lithotripsy. Human calculi were ablated with an Erbium:YAG laser in contact mode using two fibers. Optical outputs at the distal end of fibers were measured before and after laser lithotripsy. Upon the irradiation on the calculus with the 50 mJ and 100 mJ pulse energy, the output energy at the distal end of germanium fiber declined to approximately 50% of the input energy. For the sapphire fiber, the output energy at the distal end remained unchanged with 100 mJ input energy; however the output energy had dropped to 50% for 200 mJ input energy. In order to examine how the types of target tissue affect the fiber damage, the sapphire fiber was tested for the irradiation on soft tissue and water as well. No energy decline was observed during soft tissue and water irradiation. We also characterized ablation craters with both optical fibers. Both fibers produced similar craters on calculi in terms of depth and diameter. Sapphire fibers are better suited than germanium fibers for Erbium:YAG lithotripsy in terms of the fiber damage.

Cracking Difficult Biliary Stones

Phonthep Angsuwatcharakon,Rungsun Rerknimitr 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5

Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrogradecholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or abasket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are largeCBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage thesestones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for largeCBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the costof the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted ina tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization ofthe stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. Thistechnique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significanttechnical complications.

상부요관결석에 대한 요관경하배석술과 체외충격파쇄석술의 치료결과 비교

권명훈,노준화,김상익 大韓泌尿器科學會 2003 Korean Journal of Urology Vol.44 No.7

Review : How Should Biliary Stones be Managed?

( Chan Sup Shim ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.2

Minimally invasive therapy is currently invaluable for the treatment of biliary stones. Clinicians should be familiar with the various endoscopic modalities that have been evolving. I reviewed the treatment of biliary stones from the common practice to pioneering procedures, and here I also briefly summarize the results of many related studies. Lithotripsy involves procedures that fragment large stones, and they can be roughly classified into two groups: intracorporeal modalities and extracorporeal shock-wave lithotripsy (ESWL). Intracorporeal modalities are further divided into mechanical lithotripsy (ML), electrohydraulic lithotripsy, and laser lithotripsy. ESWL can break stones by focusing high-pressure shock-wave energy at a designated target point. Balloon dilation after minimal endoscopic sphincterotomy (EST) is effective for retrieving large biliary stones without the use of ML. Peroral cholangioscopy provides direct visualization of the bile duct and permits diagnostic procedures or therapeutic interventions. Biliary stenting below an impacted stone is sometimes worth considering as an alternative treatment in elderly patients. This article focuses on specialized issues such as lithotripsy rather than simple EST with stone removal in order to provide important information on state-of-the-art procedures. (Gut Liver 2010;4:161-172)

Holmium:YAG laser를 이용한 요관경하쇄석술의 초기 경험 : 기존의 쇄석술과의 결과 비교

구경완,노용수,김홍섭,양상국,나공찬 건국대학교 의과학연구소 2003 건국의과학학술지 Vol.13 No.-

Purpose: Holmium:YAG lasertripsy for the 33 patients with lower ureteral calculi compared the outcome with other results using Lithoclast and ultrasonic lithotripsy. Materials and Methods: Thirty-three patients with symptomatic urinary calculi underwent Holmium:YAG lasertripsy from March 1999 to December 2000. Twelve patients were treated with Ultrasonic lithotripsy and twenty-one patients with Lithoclast lithotripsy from April 1997 to October 1999. All calculi of the above patients were located in their lower ureters. The size of ureter stones was ranged from 3.5 mm to 12 mm (mean 6.54 mm). Results: The age of the patients ranged was from 19 to 62 years (me~n 35.7 years). After a single ureteroscopic lasertripsy calculi were conlpletely cleared in 83 % of the cases for the patients with lower ureter calculi. The immediate complications of lasertripsy were gross hematuria, fever, and flank pain. However in the long term follow up (up to 3 months after the procedures) there were no further complications, such as, vesicoureteral reflux or ureteral stricture. In other two lithotripsies Lithoclast and Ultrasonic lithotripsy accomplished calculi were completely cleared in 71 % and 74 % of cases respectively. But Holmium:Y AG lasertripsy is cleared in 94 % effectiveness. Holmium:Y AG lasertripsy is more effective than two other methods compared by stratified analysis that unmasking from confounding factors such as impacted situation. Conclusions: Lasertripsy with Holmium:Y AG laser is considered effective and safe procedure for the lower urinary calculi lithotripsy (Ultrasonic, Lithoclast).

기계적 쇄석술로 제거에 실패한 총담관결석의 체외충격파쇄석술을 이용한 제거

정광현,조정만,오일환,김수형,손병관 대한췌장담도학회 2024 대한췌담도학회지 Vol.29 No.2

총담관결석의 치료는 내시경역행담췌관조영술을 시행하여 결석을 제거하는 것이 표준적인 방법이며 내시경유두부괄약근절개술 및 내시경유두부풍선확장술을 시행한 후 바스켓 및 풍선도관, 기계석 쇄석술 등의 여러가지 방법을 사용하여 그 성공률은 90% 이상으로 알려져 있다. 그러나 일부 거대담석이나 담도협착이 동반된 경우 등에서는 담석의 제거에 실패하는 경우가 있다. 본 저자들은 방사선 비투과성 담석에 대해서 일반적인 담석제거를 위한 방법을 사용한 후에도 담석제거에 실패하고 기계적 쇄석술을 시행하던 중 바스켓의 철선이 끊어지면서 담석과 함께 총담관 내에 잔류하게 된 환자에서 체외충격파 쇄석술을 시행하여 담석을 파쇄한 후 담석의 제거에 성공하였던 증례를 문헌고찰과 함께 보고한다. The standard treatment for choledocholithiasis is to remove the stones by performing endoscopic retrograde cholangiopancreatography (ERCP). With various techniques such as basket extraction, balloon catheter extraction, mechanical lithotripsy, followed by endoscopic papillary sphincterotomy or endoscopic papillary balloon dilatation, the success rate of stone extraction is known to be over 90%. However, stone extraction can fail in cases with large common bile duct stones or biliary stricture. We report a case of impacted choledocholithiasis after conventional ERCP and mechanical lithotripsy treated with extracorporeal shock wave lithotripsy.

다양한 중재 방법을 이용한 난치성 총담관결석의 내시경 치료 증례

김아름 ( Ah Reum Kim ),황재철 ( Jae Chul Hwang ),유병무 ( Byung Moo Yoo ),김진홍 ( Jin Hong Kim ),양민재 ( Min Jae Yang ) 대한췌장담도학회 2023 대한췌담도학회지 Vol.28 No.3

난치성 담관결석은 내시경 유두 괄약근 절개술 후 EPLBD, 기계적 쇄석술, 경구담관경 유도하 담관 내 전기수압쇄석술 혹은 레이저 쇄석술, 일시적 플라스틱 담관 스텐트 삽입, 경피경간담관경유도하 쇄석술, 체외충격파쇄석술 등 다양한 시술을 통해 해결될 수 있다. 본고에서는 가용 가능한 다양한 방법을 사용하여 난치성 총담관결석을 제거한 증례를 소개하고 각각의 과정에서의 시술의 어려움을 극복하는 대응방법을 논의하고자 하였다. Clearance of a difficult biliary stone can be obtained using various interventional techniques such as endoscopic sphincterotomy followed by endoscopic papillary large balloon dilation, mechanical lithotripsy, peroral cholangioscopy-assisted intraductal electrohydraulic/laser lithotripsy, temporary plastic stent insertion, percutaneous transhepatic cholangioscopy-guided lithotripsy, and extracorporeal shock wave lithotripsy. We hereby describe the successful endoscopic treatment using various currently available interventional techniques in a case with multiple difficult common bile duct stones. Furthermore, we discuss the countermeasures to overcome the hurdles of each procedure. Korean J Pancreas Biliary Tract 2023;28(3):76-80

요관경하 배석술 후 녹농균에 의한 패혈증과 패혈성 쇼크

송진철,박천희 조선대학교 의학연구원 2017 The Medical Journal of Chosun University Vol.42 No.4

Ureteroscopic lithotripsy has higher stone free rate compared with extracorporeal shock wave lithotripsy. Ureteroscopyassociated complications are flank pain, transient hematuria, ureteral perforation, ureteral avulsion, and sepsis. Among these, sepsis is most serious complication with the incidence of about 1%. We report a case of sepsis and septic shock that developed immediately after ureteroscopic lithotripsy. It was diagnosed with elevated lactate and procalcitonin values. It was caused by Pseudomonas aeruginosa which was detected in preoperative urine culture and postoperative blood culture.