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钬激光与铥光纤激光在软组织方面的比较:一项研究。

Comparison of Holmium:YAG and Thulium Fiber Lasers on Soft Tissue: An Study.

作者信息

Doizi Steeve, Germain Thibault, Panthier Frédéric, Compérat Eva, Traxer Olivier, Berthe Laurent

机构信息

Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France.

Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France.

出版信息

J Endourol. 2022 Feb;36(2):251-258. doi: 10.1089/end.2021.0263. Epub 2022 Jan 18.

Abstract

To assess the fiber-tissue interaction through ablation, coagulation, and carbonization characteristics of the Ho:YAG laser and super pulsed thulium fiber laser (TFL) in a nonperfused porcine kidney model. To assess the degradation of laser fibers during soft tissue treatment. A 50 W TFL generator was compared with a 120 W Ho:YAG laser. The laser settings that can be set identically between the two lasers (pulse energy and frequency), and clinically relevant for prostate laser enucleation, were identified and used for tissue incisions on fresh nonfrozen porcine kidneys. For each parameter, the short, medium, and long pulse durations for the Ho:YAG generator and the different peak powers 150, 250, and 500 W for the TFL generator were also tested. Laser incisions were performed with 550 μm stripped laser fiber fixed on a robotic arm at a distance of 0.1 mm with the tissue surface and at a constant speed of 10 mm/s. Histologic analysis was then performed, evaluating incision shape, incision depth and width, axial coagulation depth, and presence of carbonization. Degradation of the laser fiber was defined as reduction of laser fiber tip length after laser activation. Incision depths and areas of coagulation were greater with the Ho:YAG laser than those with the TFL. Although no carbonization zone was found with the Ho:YAG laser, this was constant with the TFL. Although a fiber tip degradation was constantly observed with Ho:YAG laser, except in the case of a long pulse duration and low pulse energy (0.2 J), this was not the case with TFL. TFL appears to be an efficient alternative to Ho:YAG laser for soft tissue surgery. The histologic analysis found greater tissue penetration with the Ho:YAG laser and different coagulation properties between the two lasers. These results need to be investigated to assess the clinical impact of these differences and find the optimal settings for laser prostate enucleation.

摘要

在非灌注猪肾模型中,通过钬激光(Ho:YAG激光)和超脉冲铥光纤激光(TFL)的消融、凝固和碳化特性来评估纤维与组织的相互作用。评估软组织治疗过程中激光光纤的降解情况。将一台50W的TFL发生器与一台120W的Ho:YAG激光进行比较。确定了两种激光之间可以相同设置(脉冲能量和频率)且与前列腺激光剜除术临床相关的激光参数,并将其用于新鲜未冷冻猪肾的组织切割。对于每个参数,还测试了Ho:YAG发生器的短、中、长脉冲持续时间以及TFL发生器的不同峰值功率150W、250W和500W。使用固定在机械臂上的550μm裸光纤,以距组织表面0.1mm的距离、10mm/s的恒定速度进行激光切割。然后进行组织学分析,评估切口形状、切口深度和宽度、轴向凝固深度以及碳化情况。激光光纤的降解定义为激光激活后激光光纤尖端长度的缩短。Ho:YAG激光的切口深度和凝固面积大于TFL。虽然Ho:YAG激光未发现碳化区,但TFL有恒定的碳化区。虽然除了长脉冲持续时间和低脉冲能量(0.2J)的情况外,Ho:YAG激光持续观察到光纤尖端降解,但TFL并非如此。对于软组织手术,TFL似乎是Ho:YAG激光的有效替代方案。组织学分析发现Ho:YAG激光的组织穿透性更强,且两种激光的凝固特性不同。需要对这些结果进行研究,以评估这些差异的临床影响,并找到激光前列腺剜除术的最佳设置。

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