Tasca A, Cecchetti W, Zattoni F, Pagano F
Institute of Urology, University of Padua, Italy.
J Urol. 1993 Apr;149(4):709-12. doi: 10.1016/s0022-5347(17)36189-x.
We report the preliminary results of laser lithotripsy of cystine stones accomplished in 2 patients with the use of a new method of photosensitization. Transurethral rigid ureterorenoscopy was performed with an 8.5F instrument to reach 0.8 and 1.8 cm. stones located in the right and left lumbar ureters, respectively. A 320 mu. fiber was then inserted and pushed into contact with the stone. Then, 400 preliminary impulses were released from a pulsed dye laser (504 nm) with energy output at 140 mJ. and at a rate of 5 Hz. without any visible modification of the stone structure. The saline solution used as irrigation fluid was then substituted with a 2% solution of rifamycin. Totals of 95 and 152 impulses released at the same energy output previously used were then sufficient to produce a satisfactory fragmentation of the stone in both cases. Sonography and excretory urography showed no alterations of the treated urinary tract in either case. The use of rifamycin in the irrigation fluid is suggested for laser treatment of hard or nonabsorbent stones, since this substance favors optical coupling and lowers the threshold of plasma formation on the surface of the stone.
我们报告了2例使用新的光敏化方法进行胱氨酸结石激光碎石术的初步结果。使用8.5F器械进行经尿道硬性输尿管肾镜检查，分别到达位于右和左腰段输尿管的0.8厘米和1.8厘米结石处。然后插入一根320μm的光纤并将其推至与结石接触。接着，从脉冲染料激光（504nm）释放400个初始脉冲，能量输出为140mJ，频率为5Hz，结石结构未见任何明显改变。然后将用作冲洗液的生理盐水换成2%的利福平溶液。随后，以先前使用的相同能量输出分别释放95个和152个脉冲，足以使两例患者的结石均产生令人满意的碎裂。超声检查和排泄性尿路造影显示，两例患者经治疗的尿路均无改变。建议在冲洗液中使用利福平进行硬结石或非吸收性结石的激光治疗，因为这种物质有利于光学耦合并降低结石表面等离子体形成的阈值。
