Chen Shulian, Fu Ni, Cui Wei, Zhao Zeju, Luo Xu
Department of Urology, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China.
Urol J. 2019 May 13;17(3):224-227. doi: 10.22037/uj.v0i0.4955.
The aim of this study is to evaluate the impact of different pulse energy settings on dusting efficiency in flexible ureteroscopic lithotripsy (fURSL) for the treatment of upper urinary tract calculi.
Data of 88 consecutive patients who underwent fURSL for upper urinary tract calculi by a single surgeon in our department From August 2017 to August 2018 were reviewed retrospectively. Lumenis Power Suite 100W lithotripter with a 200 ?m laser fiber was used to comminute stones. According to energy settings, patients were divided into three groups- low energy group (LE: 0.3-0.6J), middle energy group (ME: 0.7-1.0J), high energy group (HE: 1.1-1.5J). Frequency was set at 30Hz in all patients. ANOVA and Chi square tests were applied to compare the difference of the mean lithotripsy and operation time, early stone-free rate (eSFR), overall stone-free rate (oSFR) and complication rate.
A total of 32, 36 and 20 patients were included in the LE, ME and HE groups, respectively. There was no difference in the age, gender distribution or in any other stone characteristics among the three groups. The mean lithotripsy time of LE, ME, HE was 10.9±7.6, 16.1±7.0, 23.0±15.0 min respectively. The mean operation time of the three groups was 16.9±7.7, 22.3±7.1, 29.2±14.9 min respectively. There were significant differences on the mean lithotripsy time (P=0.002) and the mean operation time (P=0.001) among the three groups. The stone-free rate was 31.8% and 87.5% respectively in eSFR and oSFR. No statistical significance was detected among the three groups in terms of the eSFR (P=0.89), oSFR (P=0.86), and complication rate (P=0.97).
In fURSL with dusting, low energy (0.3-0.6J) is more efficient than middle (0.7-1.0J) and high energy (1.1-1.5J). As energy increased, dusting efficiency decreased dramatically. Consequently, we recommend low pulse energy (0.3-0.6J) as the optimal dusting strategy for fURSL.
本研究旨在评估不同脉冲能量设置对输尿管软镜碎石术（fURSL）治疗上尿路结石时的清石效率的影响。
回顾性分析2017年8月至2018年8月在我科由同一外科医生为88例上尿路结石患者进行fURSL的资料。使用配有200μm激光光纤的科医人Power Suite 100W碎石机粉碎结石。根据能量设置，将患者分为三组——低能量组（LE：0.3 - 0.6J）、中能量组（ME：0.7 - 1.0J）、高能量组（HE：1.1 - 1.5J）。所有患者的频率均设置为30Hz。采用方差分析和卡方检验比较平均碎石时间、手术时间、早期结石清除率（eSFR）、总体结石清除率（oSFR）及并发症发生率的差异。
LE组、ME组和HE组分别纳入32例、36例和20例患者。三组患者在年龄、性别分布或其他结石特征方面无差异。LE组、ME组、HE组的平均碎石时间分别为10.9±7.6、16.1±7.0、23.0±15.0分钟。三组的平均手术时间分别为16.9±7.7、22.3±7.1、29.2±14.9分钟。三组间平均碎石时间（P = 0.002）和平均手术时间（P = 0.001）存在显著差异。eSFR和oSFR的结石清除率分别为31.8%和87.5%。三组在eSFR（P = 0.89）、oSFR（P = 0.86）及并发症发生率（P = 0.97）方面未检测到统计学差异。
在采用清石技术的fURSL中，低能量（0.3 - 0.6J）比中能量（0.7 - 1.0J）和高能量（1.1 - 1.5J）更有效。随着能量增加，清石效率显著降低。因此，我们推荐低脉冲能量（0.3 - 0.6J）作为fURSL的最佳清石策略。
