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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2025, Vol. 12 ›› Issue (02) : 90 -95. doi: 10.3877/cma.j.issn.2095-7157.2025.02.005

论著

经口超级微创超声波联合化学溶石碎石术治疗胆囊结石初探
翟亚奇1, 陈德鑫1,2, 吴文焘3, 姚致远2, 李明阳1,†(), 令狐恩强1,†()   
  1. 1. 100853 北京,解放军总医院第一医学中心消化内科医学部
    2. 100853 北京,解放军医学院
    3. 100190 北京,中国科学院声学研究所
  • 收稿日期:2025-04-29 出版日期:2025-05-15
  • 通信作者: 李明阳, 令狐恩强
  • 基金资助:
    国家重点研发计划(2022YFC2503603)军委后勤保障部面上项目(24BJZ18)军队高层次科技创新人才工程科研项目(GCCRC-2024-011)

Super minimally invasive surgery for gallstones:peroral transpapillary ultrasonic lithotripsy and litholysis with D-limonene in vitro

Yaqi Zhai1, Dexin Chen1,2, Wentao Wu3, Zhiyuan Yao2, Mingyang Li1,†(), Enqiang Linghu1,†()   

  1. 1. Department of Gastroenterology,The First Medical Center of Chinese PLA General Hospital,Beijing 100853,China
    2. Chinese PLA Medical School,Beijing 100853,China
    3. The Institute of Acoustics of the Chinese Academy of Sciences,Beijing 100190,China
  • Received:2025-04-29 Published:2025-05-15
  • Corresponding author: Mingyang Li, Enqiang Linghu
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翟亚奇, 陈德鑫, 吴文焘, 姚致远, 李明阳, 令狐恩强. 经口超级微创超声波联合化学溶石碎石术治疗胆囊结石初探[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(02): 90-95.

Yaqi Zhai, Dexin Chen, Wentao Wu, Zhiyuan Yao, Mingyang Li, Enqiang Linghu. Super minimally invasive surgery for gallstones:peroral transpapillary ultrasonic lithotripsy and litholysis with D-limonene in vitro[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(02): 90-95.

目的

探讨经口超级微创超声波联合化学(D-柠檬烯)溶石碎石术治疗胆囊结石的可行性和有效性。

方法

收集2024 年10 月15 日至2025 年4 月1 日解放军总医院第一医学中心胆囊切除术后新鲜胆囊结石标本72 枚,使用红外光谱法对结石进行分类(胆固醇、胆色素和混合性结石各24 枚)。 每类结石随机分配至单纯溶石组和超声波联合溶石组,两组结石的重量、大小无明显差异。单纯溶石组在37℃恒温条件下,加入20 ml D-柠檬烯,在60 转/min 低速搅拌下进行溶石,而超声波联合溶石组在单纯溶石基础上,给予1MHz 超声波联合溶石,观察8 h。 对于能够完全溶解的结石类型,比较两组的溶解时间;不能完全溶解的结石类型,比较两组的溶解率。 溶解率定义为:(操作前胆囊结石的重量-操作后胆囊结石的重量)/操作前胆囊结石的重量。

结果

超声波联合溶石组中胆固醇结石、混合性结石平均的溶解时间明显短于单纯溶石组[(36. 42 ±18. 05) min 比(130. 83 ±51.60)min(t=5.98,P <0.001)]和[(93.75 ±26.38) min 比(353.33 ±120.70)min(t =7.28,P <0.001)]。 对于胆色素结石,单纯溶石组与超声波联合溶石组的中位溶解率为(16.70%比72.46%,Z=4.175,P <0.001)。 单纯溶石组均未完全溶解,超声波联合溶石组中有5 枚结石完全溶解,其中位溶解时间为350(330,420) min。

结论

初步表明,经口超级微创超声波联合化学溶石碎石术能有效溶解胆囊结石,其溶石效率高于单纯D-柠檬烯溶石,有望为胆囊结石患者提供一种新的“保胆取石”治疗方法。

关键词: 胆囊结石, 超级微创, 超声碎石, 接触溶石, 体外实验

Objective

To assess the feasibility and efficacy of peroral transpapillary ultrasonic lithotripsy and litholysis with D-limonene for gallbladder-preserving gallstone removal in vitro experiment.

Methods

Between October 15,2024,and April 1,2025,72 fresh gallstones (24 cholesterol,24 pigment,24 mixed) were collected after cholecystectomy at the First Medical Center of Chinese PLA General Hospital and classified by infrared spectroscopy. Each stone type was randomly divided into D-limonene dissolution alone group (D-limonene group) or the other group combined with D-limonene dissolution and ultrasonic lithotripsy (hybrid group). There was no significant difference in the weight and size of the stones between the two groups. The D-limonene group received 20 mL of D-limonene at 37℃ with 60 rpm stirring for 8 hours, while the hybrid group received additional 1 MHz ultrasonic intervention. Dissolution time andefficiency were compared between the two groups. For stone types that could achieve complete dissolution, dissolution time was compared; for those that could not, dissolution rate was compared.Dissolution rate was defined as: (pre-procedure gallstone weight -post-procedure gallstone weight)/preprocedure gallstone weight.

Results

For cholesterol stones and mixed stones, the complete dissolution time in hybrid group were much shorter than those in D-limonene group (36. 42 ± 18. 05 vs. 130. 83 ±51.60 min,93.75 ±26.38 vs. 353.33 ±120.70 min, respectively, all P <0.001). For pigment stones,5 stones (41. 6%) in hybrid group achieved complete dissolution within 8 hours, while no stones in D-limonene group did. Based on the weight of residual stones, the median dissolution rate in hybrid group was much higher (72.46% vs. 16.70%, P <0.001).

Conclusion

Our in vitro experiment preliminarily showed that peroral transpapillary ultrasnonic lithotripsy and litholysis with D-limonene is feasible, and more efficient compared with D-limonene dissolution alone. With the spread of super minimally invasive surgery,it may provide a viable and promising therapeutic alternative for gallstone for gallbladder-preserving gallstone removal.

Key words: Gallstones, Super-Minimally invasive surgery, Ultrasonic lithotripsy, Contact dissolution, In vitro experiment
表1 胆囊结石基线资料(例)
项目 结石总数（n = 72） 超声波联合溶石组（n = 36） 单纯溶石组（n = 36） t 值 P 值
重量[mg,（x̄ ± s）] 665.65 ± 316.81 683.01 ± 318.73 648.28 ± 318.41 0.46 0.645
胆固醇结石 631.45 ± 251.34 684.97 ± 223.21 627.93 ± 289.29 0.54 0.594
混合性结石 667.70 ± 361.25 645.08 ± 432.27 690.33 ± 291.34 -0.30 0.766
胆色素结石 672.78 ± 338.34 719.00 ± 289.11 626.57 ± 388.72 0.66 0.516
大小[cm,（x̄ ± s）] 1.07 ± 0.29 1.03 ± 0.27 1.11 ± 0.31 -1.22 0.224
胆固醇结石 1.04 ± 0.31 0.97 ± 0.29 1.11 ± 0.32 -1.13 0.645
混合性结石 1.01 ± 0.26 1.00 ± 0.30 1.01 ± 0.21 -0.08 0.938
胆色素结石 1.18 ± 0.30 1.12 ± 0.21 1.25 ± 0.37 -0.84 0.410
图1 不同类型结石溶石效果 注:A:单纯溶石组不同类型结石的溶石效果;B:超声波联合溶石组不同类型结石的溶石效果
图2 不同类型结石的溶解率-时间曲线 注:A:胆固醇结石;B:混合性结石;C:胆色素结石
图3 经口超级微创超声波联合化学溶石碎石术示意图 注: ①微型超声换能器; ②D-柠檬烯; ③鼻胆囊引流管; ④十二指肠乳头支撑器
图4 D-柠檬烯与D-柠檬烯混合试剂 注:A(D-柠檬烯):由于D-柠檬烯疏水性,与水不互溶,结石因密度差异沉于下层的水中,与试剂接触受限;B(D-柠檬烯混合试剂):与水形成稳定的水包油(O/W)乳剂,结石充分接触试剂
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