title: Clinical application of plasma shock wave lithotripsy in treating impacted stones in the bile duct system.
abstract: OBJECTIVE
  To verify the safety and efficacy of plasma shock wave lithotripsy (PSWL) in fragmenting impacted stones in the bile duct system.
  
  
  METHODS
  From September 1988 to April 2005, 67 patients (26 men and 41 women) with impacted stones underwent various biliary operations with tube (or T-tube) drainage. Remnant and impacted stones in the bile duct system found by cholangiography after the operation were fragmented by PSWL and choledochofiberscopy. A total of 201 impacted stones were fragmented by PSWL setting the voltage at 2.5-3.5 kV, and the energy output at 2-3 J for each pulse of PSWL. Then the fragmented stones were extracted by choledochofiberscopy. The safety and efficacy of PSWL were observed during and after the procedure.
  
  
  RESULTS
  One hundred and ninety-nine of 201 impacted stones (99.0%) in the bile duct system were successfully fragmented using PSWL and extracted by choledochofiberscopy. The stone clearance rate for patients was 97% (65/67). Ten patients felt mild pain in the right upper quadrant of the abdomen, and could tolerate it well. Eleven patients had a small amount of bleeding from the mucosa of the bile duct. The bleeding was transient and stopped spontaneously within 2 min of normal saline irrigation. There were no significant complications during and after the procedure.
  
  
  CONCLUSIONS
  PSWL is a safe and effective method for fragmenting impacted stones in the bile duct system.
authors.affiliation: Department of Surgery, Third Hospital of Peking University, 49 North Garden Road, Haidian District, Beijing 100083, China. xuzhi123456@sohu.com
authors.forename: Zhi
authors.initials: Z
authors.lastname: Xu
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Wang
authors.forename: Neng-Wei
authors.initials: NW
authors.lastname: Zhang
authors.forename: Chun-Sheng
authors.initials: CS
authors.lastname: Hou
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Ling
authors.forename: Yao
authors.initials: Y
authors.lastname: Xu
authors.forename: Xiao-Si
authors.initials: XS
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002769:Cholelithiasis / Q000628:therapy*; D005260:Female; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008280:Magnetics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged