Bergmann Julius, Rosenbaum Clemens Mathias, Netsch Christopher, Gross Andreas J, Becker Benedikt
Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany.
J Clin Med. 2023 Mar 29;12(7):2588. doi: 10.3390/jcm12072588.
Laser lithotripsy during Mini-PCNL is one treatment option in urinary stone disease. In recent years, a new era in stone treatment has been initiated with the introduction of new pulsed thulium lasers. The aim of this study was to investigate the safety and efficacy of laser lithotripsy with a new pulsed solid-state thulium:YAG laser during mini-PCNL.
All patients, regardless of stone size, who were treated with a Mini-PCNL using the new pulsed thulium laser were prospectively enrolled. Operation times, stone size, laser time, and laser settings were noted. The stone-free rate was assessed postoperatively with sonography and either X-ray or computed tomography as a clinical standard. The complications were analyzed using the Clavien-Dindo classification.
A total of 50 patients with a mean age of 52 years were included. 31 (62 %) patients were male. The average stone size was 242.3 (±233.1) mm with an average density of 833 (±325) Hounsfield units. The mean operating time was 30.56 (±28.65) min, and the laser-on-time was 07:07 (± 07:08) min. The most commonly used settings were 0.4 J and 115 Hz (46 W). The mean total energy for stone ablation was 14,166 (±17,131) kJ. The total stone-free rate was 84 %, with an overall complication rate of 32% according to Clavien-Dindo (grade 1: n = 9, grade 2: n = 6, 3b: n = 1). In the group of patients with singular stones (n = 25), the stone-free rate was 88%.
The new pulsed solid-state Thulium:YAG laser allows a safe and effective lithotripsy during Mini-PCNL. The stone-free rates were high regardless of stone size with a comparable low rate of complications.
迷你经皮肾镜取石术（Mini-PCNL）中的激光碎石术是治疗尿路结石疾病的一种选择。近年来，随着新型脉冲铥激光的引入，开启了结石治疗的新时代。本研究的目的是探讨新型脉冲固态铥：钇铝石榴石（YAG）激光在Mini-PCNL期间进行激光碎石术的安全性和有效性。
前瞻性纳入所有使用新型脉冲铥激光接受Mini-PCNL治疗的患者，无论结石大小。记录手术时间、结石大小、激光时间和激光设置。术后通过超声检查以及X线或计算机断层扫描作为临床标准评估结石清除率。使用Clavien-Dindo分类法分析并发症。
共纳入50例患者，平均年龄52岁。31例（62%）为男性。平均结石大小为242.3（±233.1）mm，平均密度为833（±325）亨氏单位。平均手术时间为30.56（±28.65）分钟，激光照射时间为07:07（±07:08）分钟。最常用的设置为0.4焦耳和115赫兹（46瓦）。结石消融的平均总能量为14,166（±17,131）千焦。总结石清除率为84%，根据Clavien-Dindo分类法，总体并发症发生率为32%（1级：n = 9，2级：n = 6，3b级：n = 1）。在单发结石患者组（n = 25）中，结石清除率为88%。
新型脉冲固态铥：YAG激光在Mini-PCNL期间可实现安全有效的碎石术。无论结石大小，结石清除率都很高，并发症发生率相对较低。
