생체외 ( In - Vitro ) 에서 직접 용해제에 의한 간내 담석 용해도의 고찰

Objectives: The incidence of intrahepatic duct (IHD) stone is higher in east Asia including Korea than western contries. IHD stone has been regarded as a troublesome disease with poor surgical results. Recently, percutaneous transhepatic choledochoscopic lithotripsy with electrohydraulic lithotripsy of IHD stones showed good success rate, but it also couldn't remove stones in case of severe stenosis, acute angulation or peripheral impacted stones. A MTBE, widely used for dissolving cholesterol stone, was considered to be little effect for dissolving pigment stones. So we analysed IHD stones and dissolved them by direct solubilizer to investigate the dissolution rate of IHD stones. Methods. We have analyesd the compositions of 13 IHD stones removed during the percutaneous transhepatic cholangioscopy or pos-operative cholangioscopy by infrared spectrophotometer and dissoluted by direct solubilizer. Dry intact IHD stones were weighed and then inserted into 50ml glass tube. Within an 8hours incubation time, the 25ml of solvent were exchanged every 30minutes. After 2 and 8hours of incubation, the stone residue was dried-up at 60℃ for check weight reduction and compare to the initial dry weight. The solvent A medium was a 0.1M boric acid/sodium carbonate buffer (pH 9.4), EI)TA 1%(w/v), 1 M urea and solvent B was solvent A medium plus 0.04 M Lubrol PX and N-acethylcysteine. Results: The sites of dissolved IHD stons were both IHD stones 8cases(61.5%), left IHD stones 3(23.1%) and right IHD stones 2(15.4%), The components of IHD stones were calcium bilirubinate stones in 11cases(84.6%), followed by mixed stones 2 (15.4%). The dissolution rates after 2 and 8hours dissolution by solvent A is 11.7%, 24.7% and by solvent B is 25.7%, 62.7% respectively. The dissolution rates after 8hours in solvent B is higher than solvent A (p