Department of Surgery, University of Colorado School of Medicine, Denver, CO.
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
Urology. 2014 Apr;83(4):738-44. doi: 10.1016/j.urology.2013.11.017. Epub 2014 Jan 31.
To evaluate the association of preoperative noncontrast computed tomography stone characteristics, laser settings, and stone composition with cumulative holmium:yttrium-aluminum-garnet (Ho:YAG) laser time/energy.
We retrospectively reviewed patients who underwent semirigid/flexible ureteroscopy and Ho:YAG laser lithotripsy (200 or 365 μm laser fiber; 0.8-1.0 J energy; and 8-10 Hz rate) at 2 tertiary care centers (April 2010-May 2012). Studied parameters were as follows: patient's characteristics; stone characteristics (location, burden, hardness, and composition); total laser time and energy; and surgical outcomes.
One hundred patients met our inclusion criteria. Mean stone size was 1.01 ± 0.42 cm and volume 0.33 ± 0.04 cm(3). Mean stone radiodensity was 990 ± 296 HU, and Hounsfield units density 13.8 ± 6.0 HU/mm. All patients were considered stone free. Stone size and volume had a significant positive correlation with laser energy (R = 0.516, P <.001; R = 0.621, P <.001) and laser time (R = 0.477, P <.001; R = 0.567, P <.001). When controlling for stone size, only the correlation between HU and laser time was significant (R = 0.262, P = .011). In the multivariate analysis, with exception of stone composition (P = .103), all parameters significantly increased laser energy (R(2) = 0.524). Multivariate analysis revealed a positive significant association of laser time with stone volume (P <.001) and Hounsfield units density (P <.001; R(2) = 0.512). In multivariate analysis for laser energy, only calcium phosphate stones required less energy to fragment compared with uric acid stones. No significant differences were found in the multivariate laser time model.
Ho:YAG laser cumulative energy and total time are significantly affected by stone dimensions, hardness location, fiber size, and power. Kidney location, laser fiber size, and laser power have more influence on the final laser energy than on the total laser time. Calcium phosphate stones require less laser energy to fragment.
评估术前非增强 CT 结石特征、激光参数设置及结石成分与钬激光（holmium:yttrium-aluminum-garnet，Ho:YAG）激光时间/能量之间的相关性。
本研究回顾性分析了在 2 家三级医疗中心（2010 年 4 月至 2012 年 5 月）接受输尿管镜下钬激光碎石术（200 或 365μm 激光光纤；0.8-1.0J 能量；8-10Hz 频率）治疗的患者。研究参数包括：患者特征；结石特征（位置、负荷、硬度及成分）；总激光时间和能量；以及手术结果。
共有 100 例患者符合纳入标准。平均结石大小为 1.01 ± 0.42cm，体积为 0.33 ± 0.04cm(3)。平均结石 CT 值为 990 ± 296HU，Hounsfield 单位密度为 13.8 ± 6.0HU/mm。所有患者均达到结石无残留。结石大小和体积与激光能量（R = 0.516，P <.001；R = 0.621，P <.001）和激光时间（R = 0.477，P <.001；R = 0.567，P <.001）均呈显著正相关。在控制结石大小后，仅 HU 与激光时间之间的相关性具有统计学意义（R = 0.262，P =.011）。多变量分析显示，除结石成分（P =.103）外，所有参数均显著增加激光能量（R(2) = 0.524）。多变量分析显示，激光时间与结石体积（P <.001）和 Hounsfield 单位密度（P <.001；R(2) = 0.512）之间存在显著的正相关关系。在激光能量的多变量分析中，与尿酸结石相比，只有磷酸钙结石需要较少的能量来粉碎。在多变量激光时间模型中，未发现差异具有统计学意义。
钬激光的累积能量和总时间显著受到结石大小、硬度、位置、光纤大小和功率的影响。肾脏位置、激光光纤大小和激光功率对最终激光能量的影响大于对总激光时间的影响。磷酸钙结石需要较少的激光能量来粉碎。
