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

本研究的目的是建立一种适合非手术临床应用的内窥镜下涎腺结石切除系统，该系统采用液电碎石技术，通过舌下肉阜的开口，无任何切口，将一种精细的涎腺内窥镜引入下颌下导管。涎腺内窥镜Salivascope T PD-ZS-2002（POLYDIAGNOST GmbH，Pfaffenhofen，德国）外径为1.35 mm，具有3000像素光纤、工作通道和冲洗通道。工作通道具有0.8-mm的内径，使得电液碎石机的1.9-Fr.探针可以插入工作通道中。本研究中使用的电液碎石机是AUTOLITH^<[○！R]>（Northgate Technologies Inc.，埃尔金，美国），和1.9-Fr.探针Micro II（Northgate Technologies Inc.，埃尔金，美国）。我们用上述碎石系统对9个涎石进行了破坏实验，并分析了 ...更多信息 结果表明，冲击波作用下，硅铝石破碎后的质量、大小和冲击波的产生参数等都与硅铝石破碎后的质量、大小有关。可变参数为工作电压的功率电平和冲击波的总计数。我们还测量了每个功率水平的冲击波产生的热量。结果，9个中有7个（77.8%）被破碎，并且适合于破碎的sialoliths的参数与重量和大小（长轴和短轴）相关。破碎是在每个功率级的所有射击的综合作用下完成的。在50%功率水平下，发热量为12.6J，足以损伤涎腺导管。因此，当该系统应用于临床实践时，通过冲洗冷盐水来冷却导管内是必不可少的。因此，我们得出的结论是，尽管在手术过程中需要冷却导管，但该系统是非手术去除涎石的实用方法。使用这种新开发的唾液腺内窥镜系统，我们最后成功地以非手术方式移除一位患者的下颌下腺涎石，且没有严重的并发症。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