Emiliani Esteban, Kanashiro Andres Koey, Balaña Josep, Fontanet Sofía, Aumatell Julia, Calderón-Cortez Julio, Iregui-Parra Juan, Sanchez-Pui Antoni, Sanchez-Martin Francisco, Millan Felix, Angerri Oriol
Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain.
Department of Urology, Clinica nueva de Cali. Department of Epidemiology, Interdisciplinary Group of Research in Epidemiology and Public Health (GIESP), Libre University, Cali, Colombia.
Urolithiasis. 2023 Apr 19;51(1):75. doi: 10.1007/s00240-023-01443-5.
The aim of the study was to compare standard high-power laser (with < 80 Hz) to extended frequency (> 100 Hz) lithotripsy during miniPCNL. 40 patients were randomized in to two groups undergoing MiniPCNL. For both groups, the Holmium Pulse laser Moses 2.0 (Lumenis) was used. For group A, standard high-power laser with < 80 Hz, with Moses distance was set using up to 3 J. For Group B, extended frequency (100-120 Hz) was used allowing up to 0.6 J. All patients underwent MiniPCNL using an 18 Fr balloon access. Demographics were comparable between groups. Mean stone diameter was 19 mm (14-23) with no differences between groups (p = 0.14). Mean operative time was 91 and 87 min for group A and B (p = 0.71), mean laser time was similar in both groups, 6.5 min and 7.5 min, respectively (p = 0.52) as well as the number of laser activations during the surgery (p = 0.43). Mean Watts used was 18 and 16 respectively being similar in both groups (p = 0.54) as well as the total KJoules (p = 0.29). Endoscopic vision was good in all surgeries. The endoscopic and radiologic stone free rate was achieved in all patients expect for two in both groups (p = 0.72). Two Clavien I complications were seen, a small bleeding for group A and a small pelvic perforation in group B. The use of high-power holmium laser with extended frequency and optimized Moses was effective and safe being comparable to standard high-power laser for MiniPCNL allowing more versatility with the setting range.
本研究的目的是在微创经皮肾镜取石术（miniPCNL）期间，比较标准高功率激光（频率<80Hz）与扩展频率（>100Hz）的碎石术。40例患者被随机分为两组接受miniPCNL。两组均使用钬脉冲激光摩西2.0（科医人公司）。A组使用频率<80Hz的标准高功率激光，摩西距离设置为最多3J。B组使用扩展频率（100 - 120Hz），能量最多0.6J。所有患者均使用18F球囊通道进行miniPCNL。两组患者的人口统计学特征具有可比性。平均结石直径为19mm（14 - 23mm），两组之间无差异（p = 0.14）。A组和B组的平均手术时间分别为91分钟和87分钟（p = 0.71），两组的平均激光时间相似，分别为6.5分钟和7.5分钟（p = 0.52），手术期间的激光激活次数也相似（p = 0.43）。两组平均使用的瓦特数分别为18和16，相似（p = 0.54），总千焦数也相似（p = 0.29）。所有手术的内镜视野均良好。除两组各有2例患者外，所有患者均实现了内镜和放射学无石率（p = 0.72）。观察到2例Clavien I级并发症，A组有少量出血，B组有小的盆腔穿孔。使用扩展频率和优化摩西技术的高功率钬激光有效且安全，与标准高功率激光用于miniPCNL相当，在设置范围上具有更多的通用性。
