胃镜下激光引爆微爆破碎石术与钬激光碎石术治疗胃石症的疗效比较

目的 评价并比较胃镜下Nd：YAG激光引爆微爆破碎石术和钬激光碎石术治疗胃石症的疗效及安全性，探讨胃石症的有效治疗手段。方法 对368例胃石症患者的402块胃石进行了胃镜下碎石治疗。Nd：YAG激光引爆微爆破碎石术组260例共285块胃结石，男性177例，女性83例，年龄5～78岁，平均37．6岁。钬激光碎石术组，108例共117块胃结石，男性61例，女性47例，年龄8～67岁，平均36．8岁。结果 全部患者均获得治愈，仅Nd：YAG激光引爆微爆破碎石术组1例患者发生胃穿孔，经手术治愈，其余患者未发生任何术中及术后并发症。Nd：YAG激光引爆微爆破碎石术组260例经1次治疗治愈220例占84．6％，其余患者经2次治疗均获得治愈，每次治疗平均耗时8min。钬激光碎石术组108例患者1次治疗治愈62例占57％；经2次治疗治愈41例占38％；5例经3次治疗治愈，治愈率达100％，每次治疗平均耗时15min。结论 胃镜下Nd：YAG激光引爆微爆破碎石术和钬激光碎石术两种方法治疗胃石症均安全有效。Nd：YAG激光引爆微爆破碎石术由于碎石效率高比钬激光碎石术耗时更短，操作更快捷，患者痛苦更小；而钬激光碎石术则更加安全，但钬激光机价格昂贵，不如前者容易普及。

Endoscopic Lithotripsy with Holmium:YAG Laser and Laser Ignited Mini-Explosive Technique of Gastric Bezoars

Objective To evaluate the holmium:YAG laser and laser ignited mini-explosive technique in the treatment of gastric bezoars. Methods Endoscopic lithotripsy with laser ignited mini-explosive technique was performed on 260 patients with altogether 285 gastric bezoars, including 177 males and 83 females, aging from 5 to 78 (mean 37 6y) 108 patients with a total of 117 gastric bezoars received endoscopic lithotripsy with holmium:YAG laser, among whom 61 were males and 47 females, aging from 8 to 67 (mean 36 8y). Results All the patients were cured with a curative effective rate of 100%. The average time that each case took in laser ignited mini-exploseve technique group was 8 minutes, while 15 minutes were needed in each patient in holmium:YAG laser group. No interoperative or delayed complications were found except gastric perforation occurred in one patient in laser ignited mini-explosion group, who was surgerilly cured later. Conclusions Endoscopic lithotripsy with holmium:YAG laser and laser ignited mini-explosive technique are both effective and safe ways in treatment of gastric bezoars. It takes a little bit longer time in holmium:YAG laser technique, but more safer. And it is a more expensive equipment that not all the health care centers can afford it.