用于碎石术的铥光纤激光器：经皮肾镜取石术的首次临床经验
Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy.
作者信息
Enikeev Dmitry, Taratkin Mark, Klimov Roman, Alyaev Yuriy, Rapoport Leonid, Gazimiev Magomed, Korolev Dmitry, Ali Stanislav, Akopyan Gagik, Tsarichenko Dmitry, Markovina Irina, Ventimiglia Eugenio, Goryacheva Evgenia, Okhunov Zhamshid, Jefferson Francis A, Glybochko Petr, Traxer Olivier
机构信息
Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation.
Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia.
出版信息
World J Urol. 2020 Dec;38(12):3069-3074. doi: 10.1007/s00345-020-03134-x. Epub 2020 Feb 27.
PURPOSE
To evaluate the efficacy and safety of thulium-fiber laser (TFL) in laser lithotripsy during percutaneous nephrolithotomy (PCNL).
METHODS
Patients with stones < 30 mm were prospectively recruited to undergo PCNL using TFL "FiberLase" (NTO IRE-Polus, Russia). Stone size, stone density, operative time, and "laser on" time (LOT) were recorded. Study included only cases managed with fragmentation. Stone-free rate and residual fragments were determined on postoperative computer tomography. Complications were classified using the Clavien-Dindo grade. Stone retropulsion and endoscopic visibility were assessed based on surgeons' feedback using a questionnaire.
RESULTS
A total of 120 patients were included in the study with a mean age of 52 (± 1.8) years; of these 77 (56%) were males. Mean stone size was 12.5 (± 8.8) mm with a mean density of 1019 (± 375) HU. Mean operative time was 23.4 (± 17.9) min and mean LOT was 5.0 (± 5.7) min. Most used settings were of 0.8 J/25-30 W/31-38 Hz (fragmentation). The mean total energy for stone ablation was 3.6 (± 4.3) kJ. Overall stone-free rate was 85%. The overall complication rate was 17%. Surgeons reported stone retropulsion that interfered with surgery in 2 (1.7%) cases insignificant retropulsion was noted in 16 (10.8%) cases. Poor visualization was reported in three (2.5%) cases and minor difficulties with visibility in four (3.3%) cases.
CONCLUSIONS
TFL is a safe and effective modality for lithotripsy during PCNL and results in minimal retropulsion.
目的
评估铥光纤激光（TFL）在经皮肾镜取石术（PCNL）中进行激光碎石的有效性和安全性。
方法
前瞻性招募结石小于30mm的患者，使用“FiberLase”铥光纤激光（俄罗斯NTO IRE-Polus公司）进行PCNL。记录结石大小、结石密度、手术时间和“激光开启”时间（LOT）。研究仅纳入采用碎石术治疗的病例。术后通过计算机断层扫描确定无石率和残留碎片情况。使用Clavien-Dindo分级对并发症进行分类。根据外科医生的问卷反馈评估结石后推和内镜视野情况。
结果
本研究共纳入120例患者，平均年龄52（±1.8）岁；其中77例（56%）为男性。平均结石大小为12.5（±8.8）mm，平均密度为1019（±375）HU。平均手术时间为23.4（±17.9）分钟，平均LOT为5.0（±5.7）分钟。最常用的参数设置为0.8J/25 - 30W/31 - 38Hz（碎石）。结石消融的平均总能量为3.6（±4.3）kJ。总体无石率为85%。总体并发症发生率为17%。外科医生报告2例（1.7%）结石后推干扰手术，16例（10.8%）发现轻微后推。3例（2.5%）报告视野不佳，4例（3.3%）报告视野有轻微困难。
结论
TFL是PCNL期间安全有效的碎石方式，且后推作用极小。
Zotero 插件