AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique. METHODS: Th...AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique. METHODS: The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm. Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter. RESULTS: Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 ± 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis). CONCLUSION: The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.展开更多
BACKGROUND: Hepatolithiasis is very common in East Asia. It is benign in nature, but has a high recurrence rate. It is likely to lead to biliary cirrhosis and increase the risk of cholangiocarcinoma. Hence, the treatm...BACKGROUND: Hepatolithiasis is very common in East Asia. It is benign in nature, but has a high recurrence rate. It is likely to lead to biliary cirrhosis and increase the risk of cholangiocarcinoma. Hence, the treatment of hepatolithiasis is difficult but vital. In this report, we present a novel approach to manage hepatolithiasis using the choledochoscopic Frequency-Doubled Double pulse Nd:YAG (FREDDY) laser lithotripsy combined with or without hepatectomy. METHODS: Between July 2009 and October 2012, 45 patients underwent choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy (laser lithotripsy group). Fortyeight patients underwent a traditional operation (traditional method group) from January 2009 to June 2009. Comparative analysis was made of demographic and clinical characteristics of the two groups. RESULTS: The final stone clearance rate of the laser lithotripsy group was 93.3%, whereas that of the traditional method group was 85.4% (P=0.22). In the laser lithotripsy group, 2 patients experienced hemobilia and 3 patients had acute cholangitis. In the traditional method group, 3 patients had intraoperative hemorrhage, 1 patient had bile leakage, 6 patients had acute cholangitis, and 1 patient died of liver failure. Moreover, the operative time in the traditional method group was significantly longer than that in the laser lithotripsy group (P=0.01). The mean hospital stay of the patients in the traditional method group was longer than that in the laser lithotripsy group (9.8 vs8.2 days, P=0.17). Recurrent intrahepatic bile duct stones were not found during the follow-up period in the two groups. CONCLUSION: Operative choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy may be an effective and safe treatment for hepatolithiasis.展开更多
The experiment of Nd： YAG pulsed laser self-fluxing welding for 304 stainless steel/Ti6Al4V titanium alloy dissimilar metal was carried out. The microstructure properties of welded joint were analyzed by SEM, EDS and...The experiment of Nd： YAG pulsed laser self-fluxing welding for 304 stainless steel/Ti6Al4V titanium alloy dissimilar metal was carried out. The microstructure properties of welded joint were analyzed by SEM, EDS and XRD. The equilibrium lattice constants, enthalpies of formation, cohesive energies, mechanical properties, Debye temperatures and valence electron structures of Ti-Fe intermetallic compounds （IMCs） were calculated by the first principle pseudopotential plane wave method based on density functional theory （DFT）. According to the thermodynamic data of Ti-Fe-Cr compounds, the Gibbs free energy per mole of compound at different temperatures was calculated and their thermal stability was compared. The results show that there are no macroscopic cracks in the welded joints, and the IMCs distributed evenly along the welding interface exhibits 3 distinct layers of microstructure with different colors. The welds interface generates IMCs of TiFe, TiFe 2 and a small amount of Ti 5Cr 7Fe 17 IMCs. Ti-Fe IMCs with high thermodynamic stability and easy alloying formation. The results of Gibbs free energies show that the sequence of precipitates in the interface is Ti 5Cr 7Fe 17 , TiFe 2 and TiFe in high temperature during the metallurgical reaction. The G/B values of Ti-Fe IMCs are greater than the critical value of 0.5, indicating that it is an intrinsic brittleness.展开更多
基金The 2007 research fund of Wonkwang University and Wonkwang Clinical Research Institute
文摘AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique. METHODS: The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm. Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter. RESULTS: Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 ± 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis). CONCLUSION: The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.
基金supported by grants from the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (81121002)Zhejiang Provincial Natural Science Foundation (Y2100498)
文摘BACKGROUND: Hepatolithiasis is very common in East Asia. It is benign in nature, but has a high recurrence rate. It is likely to lead to biliary cirrhosis and increase the risk of cholangiocarcinoma. Hence, the treatment of hepatolithiasis is difficult but vital. In this report, we present a novel approach to manage hepatolithiasis using the choledochoscopic Frequency-Doubled Double pulse Nd:YAG (FREDDY) laser lithotripsy combined with or without hepatectomy. METHODS: Between July 2009 and October 2012, 45 patients underwent choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy (laser lithotripsy group). Fortyeight patients underwent a traditional operation (traditional method group) from January 2009 to June 2009. Comparative analysis was made of demographic and clinical characteristics of the two groups. RESULTS: The final stone clearance rate of the laser lithotripsy group was 93.3%, whereas that of the traditional method group was 85.4% (P=0.22). In the laser lithotripsy group, 2 patients experienced hemobilia and 3 patients had acute cholangitis. In the traditional method group, 3 patients had intraoperative hemorrhage, 1 patient had bile leakage, 6 patients had acute cholangitis, and 1 patient died of liver failure. Moreover, the operative time in the traditional method group was significantly longer than that in the laser lithotripsy group (P=0.01). The mean hospital stay of the patients in the traditional method group was longer than that in the laser lithotripsy group (9.8 vs8.2 days, P=0.17). Recurrent intrahepatic bile duct stones were not found during the follow-up period in the two groups. CONCLUSION: Operative choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy may be an effective and safe treatment for hepatolithiasis.
基金supported by the National High Technology Research and Development Program of China(Grant No.2013AA041003)the National Natural Science Foundation of China(Grant No.51365039)
文摘The experiment of Nd： YAG pulsed laser self-fluxing welding for 304 stainless steel/Ti6Al4V titanium alloy dissimilar metal was carried out. The microstructure properties of welded joint were analyzed by SEM, EDS and XRD. The equilibrium lattice constants, enthalpies of formation, cohesive energies, mechanical properties, Debye temperatures and valence electron structures of Ti-Fe intermetallic compounds （IMCs） were calculated by the first principle pseudopotential plane wave method based on density functional theory （DFT）. According to the thermodynamic data of Ti-Fe-Cr compounds, the Gibbs free energy per mole of compound at different temperatures was calculated and their thermal stability was compared. The results show that there are no macroscopic cracks in the welded joints, and the IMCs distributed evenly along the welding interface exhibits 3 distinct layers of microstructure with different colors. The welds interface generates IMCs of TiFe, TiFe 2 and a small amount of Ti 5Cr 7Fe 17 IMCs. Ti-Fe IMCs with high thermodynamic stability and easy alloying formation. The results of Gibbs free energies show that the sequence of precipitates in the interface is Ti 5Cr 7Fe 17 , TiFe 2 and TiFe in high temperature during the metallurgical reaction. The G/B values of Ti-Fe IMCs are greater than the critical value of 0.5, indicating that it is an intrinsic brittleness.
