Die percutane transhepatische Laserlithotripsie von Gallenblasensteinen ? Tierexperimentelle Ergebnisse

Abstract

Since laserinduced shock wave lithotripsy of gallstones is possible for treatment of common bile duct stones, the percutaneous transhepatic laserlithotripsy of stones in the gallbladder is examined in an animal study. In 8 animal experiments it could be shown that puncture of the gallbladder, dilatation of the working channel, (laserinduced) shock wave lithotripsy, removal of the fragments and the instruments are possible in one session. Neither when performing simple closure of the wound by suture nor by fibrinsealing severe side-effects could be recognized. After laserlithotripsy ablation of epithelium and hematomas can be observed, which are restituted within one month. The experiments show that in organ-saving shockwave lithotripsy there is no need for waiting for the development of a fistula and the percutaneous approach can be simplified.

Percutaneous Rotational Lithotripsy of Gallbladder Stones

“…This is especially the case in patients who have undergone percutaneous cholecystostomy for treatment of acute cholecystitis. Gallbladder edema and minor mucosal hemorrhage appear during rotational lithotripsy as shown in animal experiments by us and others (17,19), but this has also been shown after percutaneous laser lithotripsy (37) and ESWL (30). The mucosal edema and hemorrhage can make it difficult to verify the total clearance of stone fragments and debris.…”

Sclerotherapy of Edematous Gallbladders with Different Agents

“…It is obvious that rotolithotripsy causes an edema of the gallbladder wall (19,20). Severe gallbladder wall edema and small mucosal bleedings have also been reported in animal experiments with percutaneous electrohydraulic lithotripsy (I) and with percutaneous transhepatic Laser-lithotripsy (30). Transient gallbladder wall edema after ESWL in humans has been demonstrated with ultrasonography (23) and with CT (13).…”