Contact Ultrasonic Lithotripsy in the Lumen of the Common Bile Duct

Abstract


Relevance Choledocholithiasis occurs in about 18-36% of patients with calculous cholecystitis, and in elderly patients is more common than in the young. Available methods of laparoscopic common bile duct revision enough laborious and not always successful. Using endoscopic papillosphincterotomy subsequently leads to disruption of the reflex sphincter function and development of papillary insufficiency, also does not guarantee the removal of large stones. Consequently, the need and urgency of finding solutions to low-traumatic removal of stones from the common bile duct in individuals at high risk of surgical intervention, especially when the residual choledocholithiasis. The purpose of the study To decrease trauma treatment of choledocholithiasis using contact ultrasound lithotripsy in the lumen of the common bile duct. Materials and methods To perform lithotripsy in the lumen of the common bile duct was created waveguide original design. In in vitro experiments produced crushing stones extracted from the gall bladder of patients operated on for gallstones, various compositions. In in vivo experiments used 20 adult mongrel rabbits after modeling cholelithiasis by replanting calculus gallbladder voiced its cavity for 4 minutes. To study the pathological effects of these parameters ultrasound articulated wall of the intestine and the diaphragmatic surface of the liver for 3-7 minutes. Results and their discussion It was established experimentally that the optimal parameters for performing lithotripsy: output power 35%, from 40 to 65 watts, 26500-26700 Hz frequency. More mineralized, pigment stones are fragmented faster than cholesterol, medium and low-mineralized stones. In vivo experiments, in all cases in the cavity of the gallbladder found the remains of the calculus in the form of small fragments of sizes up to 0.5 mm. Pathological changes in irradiated tissues is minimal and completely leveled to 14 days after exposure to ultrasound. Conclusion Thus, in an effort to preserve the sphincter apparatus major duodenal papilla, the proposed waveguide can be successfully used in the treatment of gallstone disease without the threat of deep soft tissue injuries. Design of the waveguide allowsduring laparoscopic surgery to penetrate into the lumen of the common bile duct stones and make the fragmentation that would significantly reduce traumatic intervention.

Chita State Medical Academy, 39A Gor'kogo Str., Chita, 672090, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com

Russian Federation Ph.D., Associate Professor of Department of Surgery of Chita State Medical Academy

Chita State Medical Academy, 39A Gor'kogo Str., Chita, 672090, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation MD, Professor, Head. Department of Surgery of Chita State Medical Academy;

Chita State Medical Academy, 39A Gor'kogo Str., Chita, 672090, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation MD, Professor of Chemistry and Biochemistry of Chita State Medical Academy

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