探索在肾脏模型中实现安全有效的铥纤维激光碎石术的最佳参数。
Exploring optimal settings for safe and effective thulium fibre laser lithotripsy in a kidney model.
机构信息
Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
出版信息
BJU Int. 2024 Feb;133(2):223-230. doi: 10.1111/bju.16218. Epub 2023 Nov 27.
OBJECTIVES
To explore the optimal laser settings and treatment strategies for thulium fibre laser (TFL) lithotripsy, namely, those with the highest treatment efficiency, lowest thermal injury risk, and shortest procedure time.
MATERIALS AND METHODS
An in vitro kidney model was used to assess the efficacy of TFL lithotripsy in the upper calyx. Stone ablation experiments were performed on BegoStone phantoms at different combinations of pulse energy (E ) and frequency (F) to determine the optimal settings. Temperature changes and thermal injury risks were monitored using embedded thermocouples. Experiments were also performed on calcium oxalate monohydrate (COM) stones to validate the optimal settings.
RESULTS
High E /low F settings demonstrated superior treatment efficiency compared to low E /high F settings using the same power. Specifically, 0.8 J/12 Hz was the optimal setting, resulting in a twofold increase in treatment efficiency, a 39% reduction in energy expenditure per unit of ablated stone mass, a 35% reduction in residual fragments, and a 36% reduction in total procedure time compared to the 0.2 J/50 Hz setting for COM stones. Thermal injury risk assessment indicated that 10 W power settings with high E /low F combinations remained below the threshold for tissue injury, while higher power settings (>10 W) consistently exceeded the safety threshold.
CONCLUSIONS
Our findings suggest that high E /low F settings, such as 0.8 J/12 Hz, are optimal for TFL lithotripsy in the treatment of COM stones. These settings demonstrated significantly improved treatment efficiency with reduced residual fragments compared to conventional settings while keeping the thermal dose below the injury threshold. This study highlights the importance of using the high E /low F combination with low power settings, which maximizes treatment efficiency and minimizes potential thermal injury. Further studies are warranted to determine the optimal settings for TFL for treating kidney stones with different compositions.
目的
探索钬纤维激光（TFL）碎石术的最佳激光参数和治疗策略，即具有最高治疗效率、最低热损伤风险和最短治疗时间的参数和策略。
材料和方法
采用体外肾模型评估 TFL 在上盏结石中的碎石效果。在不同的脉冲能量（E）和频率（F）组合下对 BegoStone 结石模型进行碎石实验，以确定最佳参数。通过嵌入式热电偶监测温度变化和热损伤风险。还对一水合草酸钙（COM）结石进行了实验，以验证最佳参数。
结果
与相同功率的低 E/高 F 参数相比，高 E/低 F 参数显示出更高的治疗效率。具体来说，0.8 J/12 Hz 是最佳参数，与 0.2 J/50 Hz 参数相比，治疗效率提高了一倍，单位碎石质量的能量消耗降低了 39%，残余碎片减少了 35%，总治疗时间减少了 36%。COM 结石的热损伤风险评估表明，10 W 功率下高 E/低 F 参数组合仍低于组织损伤阈值，而更高的功率设置（>10 W）始终超过安全阈值。
结论
我们的研究结果表明，高 E/低 F 参数（如 0.8 J/12 Hz）是治疗 COM 结石的 TFL 碎石术的最佳参数。与传统参数相比，这些参数的残余碎片明显减少，同时治疗效率显著提高，且热剂量保持在损伤阈值以下。本研究强调了使用低功率设置的高 E/低 F 组合的重要性，这最大限度地提高了治疗效率并降低了潜在的热损伤风险。需要进一步的研究来确定 TFL 治疗不同成分肾结石的最佳参数。
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