内镜下激光引爆碎石术治疗胃结石12年经验总结

12 Years Experience of Gastric Bezoars Treatment by Endoscopic Lithotripsy with Laser Ignited Mini-explosive Technique

目的 总结 12年应用内镜下激光引爆技术治疗胃结石的经验。方法 从 1988年 1月到 2 0 0 0年 3月应用内镜下激光引爆碎石术 ,共治疗胃结石病人 2 0 6例 ,其中男性 15 0例 ,女性 5 6例 ,年龄5～ 78岁。首先 ,经胃镜活检管道插入前端装有微型炸药头 (微型不锈钢管内装叠氮化铅 1 5mg)光纤 ,近端与Nd∶YAG脉冲激光引爆碎石机 (波长 1 0 5 μm ,能量 5 0 0～ 70 0mJ脉冲峰值能量 90 0mJ,脉冲宽度 4～ 5ns)相连 ,使药头顶住结石中心稳定后引爆。引爆后胃内注入 10 %碳酸氢钠溶液 15 0～ 2 0 0ml,使结石残渣排出。术后 2～ 4周胃镜复查。结果 共治疗 2 0 6例胃结石病人 ,治愈率达 10 0 %。一次治疗的治愈率从原来的 70 %提高到 90 %。结论 内镜下激光引爆碎石术治疗胃结石安全、有效 ,值得推广。

Objective To summarize 12 years experience in application of endoscopic lithotripsy by laser ignited mini-explosive technique. Methods From January 1988 to march 2000, 206 cases(male 150, female 56; age from 5 to 78 years) of gastric bezoars were treated successfully using endoscopic lithotripsy by laser ignited mini-explosive technique. The distal end of fiber with mini-explosive head (mini-stainless steel tube counting 1 5 mg CMC-Pb(N 3) 2) was passed through the endoscopic biopsy channel to the gastric bezoars. The proximal end of fiber was combined with laser igniting device (Nd∶YAG pulse laser, wave length 1 05 μm, power of output 500-700 mJ). The distal mini-explo-sive head was ignited with laser when it targeted at the center of gastric bezoars surface firmly, thus the gastric bezoars were broken. To discharge the fragments of gastric bozoars, 150-200 ml solution of 10% Na(H)CO 3 was injected into the stomach. Endoscopic examination was repeated from two to four weeks after treatment. Results The overall successful rate was 100%. The cure rate of one treatment was improved from 70% to 90%. Conclusions The endoscopic lithotripsy with laser ignited mini-explosive technique appeared to be a safe, effective and promising alternative for the gastric bezoars treatment and worthy of popularization.