Experimental Study on Development of Sialendoscopic Sialolithectomy System using Intracorporeal Electrohydraulic Lithotripsy

本研究的目的是建立一种适用于非手术临床应用的新型体内电液碎石内镜下涎石切除术系统。我们研制了一种优良的涎内窥镜，它可以通过舌下管的开口进入下颌下管，而不需要任何切口。唾液内窥镜，Salivascope T PD-ZS-2002 （polydiagnostic GmbH, Pfaffenhofen, Germany）外径1.35 mm，有3000像素的光纤，一个工作通道和一个灌溉通道。工作通道的内径为0.8 mm，因此1.9 fr。电液碎石机探头可插入工作通道。本研究使用的电液碎石机为AUTOLITH^< <〇！> (Northgate Technologies Inc., Elgin, usa)，和一个1.9-Fr。探针，Micro II （Northgate Technologies Inc., Elgin, usa）。利用上述碎石系统对9块微晶岩进行了破碎实验，分析了微晶岩的重量、尺寸与破碎冲击波产生参数的关系。可变参数为工作电压功率级和冲击波总计数器。我们还测量了每个功率级的冲击波所产生的热量。结果表明，9个硅屑岩中有7个（77.8%）破碎，适合破碎的参数与硅屑的重量和尺寸（长轴和短轴）相关。这些碎片是在每个功率水平的所有镜头的综合效果下完成的。在50%的功率水平下，热量为12.6 J，足以损伤唾液腺导管。因此，当该系统应用于临床实践时，通过冲洗冷盐水在管道内冷却是必不可少的。因此，我们得出结论，尽管在手术过程中需要冷却导管，但该系统是非手术去除唾液石的实用方法。使用这种新开发的唾液内镜系统，我们最终成功地去除了患者的颌下腺的唾液石，没有严重的并发症。少

The purpose of this study was to establish a new endoscopic sialolithectomy system using intracorporeal electrohydraulic lithotripsy suitable for the non-surgical clinical use.We developed a fine sialendoscope, which could be introduced to the submandibular duct through the opening of sublingual caruncula without any incision. The sialendoscope, Salivascope T PD-ZS-2002 (POLYDIAGNOST GmbH, Pfaffenhofen, Germany) with a 1.35-mm outer diameter, has 3000-pixels optic fibers, a working channel, and an irrigation channel. The working channel has a 0.8-mm inner diameter so that a 1.9-Fr. probe of an electrohydraulic lithotripter can be inserted into the working channel. The electrohydraulic lithotripter used in this study is AUTOLITH^<【○!R】> (Northgate Technologies Inc., Elgin, U.S.A.), and a 1.9-Fr. probe, Micro II (Northgate Technologies Inc., Elgin, U.S.A.).We performed an experiment to destroy 9 sialoliths using above-mentioned lithotripsy system and analyze the relationship between the … More weight and size of the sialoliths and the generating parameters of shock wave in which the sialoliths were fragmented. The variable parameters were power level of operating voltage and total counters of shock wave. We also measured the quantity of heat generated by shooting the shock wave of each power level.As a result, 7 of 9 sialoliths (77.8%) were fragmented, and the parameters suitable for fragmentation of the sialoliths are correlated with the weight and size (long axis and short axis). The fragmentations were accomplished with the integrated effect of all shots of each power level. The heat quantity was 12.6 J at 50% of power level, and enough high to injure the duct of salivary gland. Therefore, cooling within the duct by irrigating cold saline is essential when this system is applied to the clinical practice.Thus, we concluded that this system is practical method to remove the sialolith non-surgically, although cooling of the duct should be needed during the procedure.Using this newly developed sialendoscopy system, we finally succeeded to remove a sialolith of the submandibular gland of a patient non-surgically with no severe complication. Less