Clinical Research Of Electrohydraulic Lithotripsy Effect In Cholelithiasis

Objective1.To evaluate electrohydraulic lithotripsy effect of postoperative residual biliary stones under biliary endoscopy through fistula of T tube;2.To analyse the relationship between the gallstone nature(size,location, composition) and the lithotripsy energy,providing a scientific basis for the clinical application of electrohydraulic lithotriptor.Methods1.Collect the lithotripsy information of cholelithiasis patients from September 2008 to March 2009 in Qilu Hospital of Shandong University, including:the size and location of gallstone,lithotripsy energy and number;2.The specimens was send to the Shandong University of Chemistry and Chemical Experiment Teaching Center,using Fourier transform infrared spectrometer(ALPHA-T Bruker,German) to test samples of the percentage of cholesterol and bilirubin calcium content;3.The gallstone size,gallstone location,cholesterol concentration,bilirubin calcium concentration as the independent variables,the corresponding total lithotripsy energy of the stone as the dependent variable,using SPSS 16.0 statistical package and set up a database for statistical analysis:multivariate linear relationship between gallstone nature(size,location,composition)and the lithotripsy energy.Results1.Gallstone size:the stones,from 9 cases of gallstone patients,need to be treated by lithtripter take a total of 52,9 patients with this stone are with a high-density shadow on CT photos,determinate the stone size before lithtriptsy on this CT photos;the biggest is 22mm,minimum is 5mm;an average is 9.90mm.2.Gallstone location:the all gallstones location:9 cases of common bile duct,3 cases of common hepatic duct,13 cases of left and right hepatic duct (grade one),16 cases of the hepatic leaf bile duct(grade two:the left inside leaf, the left outside leaf,the right anterior leaf,the right posterior leaf),11 cases of the hepatic segments bile duct(grade three,including caudate leaf).The intrahepatic bile duct stones accounted 76.92%,so the stones that hard to be taken out are still mainly at intrahepatic bile duct.The stones within common bile duct and hepatic duct are usually because too large to be removed out by using reticular basket under endoscopy;The stones within intrahepatic bile duct are usually because the stones incarcerated and can not be removed out.3.The determination of gallstone composition:cholesterol concentration at 12.7%～40.4%,averaging 21.54%;bilirubin calcium level at 0.16%～42.79%, averaging 14.61%.4.Lithotripsy energy:The instrument parameters of electrohydraulic lithotripter:single pulse,gravel energy0.35kj～0.45kj;Therefore:the total energy = gravel energy×the impact number of the gravel energy.the total lithotripsy energy of the 52 stones between0.7～11.7kj,average4.085kj.5.The relationship between gallstone nature(size,location,composition) and the total lithotripsy energy:multiple regression analysis showed that:in all factors,only the gallstone location has little effect on the total lithotripsy energy; gallstone size,bilirubin calcium concentration and cholesterol concentration all have impaction on the total lithotripsy energy,partial regression coefficients were0.520,7.142and-4.934(P value＜0.001).According to the results of the analysis,we can set up an index model of lithotripsy effect(lithotripsy effect, LE),LE = -1.027 +0.520 X₁ +7.142 X₂-4.934X₃(X₁:gallstone size,X₂:bilirubin calcium concentration,X₃:cholesterol concentration).Calculated by the model results can be drawn as follows:in the same component,the size of stone the bigger the greater the energy required;in the same size of stone and bilirubin calcium concentration,the more cholesterol the less energy required;in the same cholesterol concentration and stone size,the more bilirubin calcium the more energy required.Conclusions1.Treatment of electrohydraulic lithotripsy in postoperative residual biliary stones under biliary endoscopy through fistula of T tube is safe and effective.2.Analysis indicates that the larger the stone in diameter,the greater the bilirubin calcium concentration,and the smaller the cholesterol concentration, the needs of electrohydraulic lithotripsy shock wave energy are greater.3.The statistical analysis of our model can be used to calculate the energy of lithotripsy stones,and estimate the probability of success,as well as guide the selection of a safe energy threshold for the stone.