腹腔鏡下胆嚢摘出術におけるNd: YAGレーザー第二高調波およびフラッシュランプ励起パルス波ダイレーザーの応用

抄録

Recently we applied surgical lasers to laparoscopic cholecystectomy which promptly became the most common treatment for cholecystolithiasis. From September 1990 to August 1993, 225 patients with cholecystolithiasis underwent this operation and 10 patients of these were complicated choledocholithiasis. KTP laser was used for dissection of the gallbladder bed of the liver in 50 cases, comparing with the group where only electrocautery was used. A quartz fiber was introduced into the abdominal cavity though a lumen of aspiration nozzle or Laser Scalpel which has U-shaped metal tip. The usefulness of KTP laser was investigated from the standpoint of accidental entry to the gallbladder or the liver, ability of hemostasis, and GOT/GPT values in the postoperative period. Pulsed-dye laser was applied to fracture stones in the common bile duct. A quartz fiber was inserted through a working channel of choledochoscope. Inadvertent entry into the gallbladder was occurred in 12.0%(6/50) of the KTP laser group and 18.0%(21/117) of the electrocautery group. Resected specimen revealed that no hepatic parenchyma was found in the KTP laser group but it was recognized in 13.3% of the electrocautery group. Laser Scalpel make manipulation of quartz fiber easier by holding it within the“U”tip. The value of transaminases was lower in the KTP laser group though there was no significant difference. Pulsed-dye laser was used in 5 cases. In only one case, choledocholithiasis cleared at operation. In three cases, small fragments remained but disappeared during postoperative period. In one case, endoscopic sphincterotomy was required to remove the residual stone. Mechanical excoriation by quarts fiber may cause bleeding from the bile duct.
Clinically, surgical lasers are safe and effective in the procedures of laparoscopic cholecystectomy and management of choledocholithiasis through the cystic duct.