Grasso M
Department of Urology, New York University Medical School, NY 10016, USA.
Urology. 1996 Aug;48(2):199-206. doi: 10.1016/S0090-4295(96)00158-6.
To study, in a clinical series, the safety and efficacy of holmium laser energy applied as an endoscopic lithotrite.
Over a 2-year period, patients with urinary tract calculi were treated endoscopically with the holmium laser lithotripter, and data were gathered prospectively. Holmium lasers with maximum outputs of 15, 25, and 60 W were used. Various low water density, quartz fiber delivery systems were developed for specific applications. In addition, various combinations of endoscopes and laser fibers were employed.
A total of 63 patients with 75 calculi were treated. All calculi were cleared endoscopically. Minimal variation in laser efficiency was noted with different stone compositions, including cystine. Thirty-three of 34 ureteral calculi were treated to completion in one sitting (97%). Twenty-nine renal stone burdens were treated with the holmium laser, 26 of which were treated solely in a retrograde fashion. Of the latter, 23 (88.5%) required only a single sitting. Complications from holmium laser energy, including ureteral stricture disease, were not encountered in this series. Patients with complex, large stone burdens were treated to completion without sequelae. The combination of the actively deflectable, flexible ureteroscope and 200-microns fiber facilitated clearance of 18 lower-pole caliceal calculi. Three patients with partial staghorn stone burdens averaging 30 mm in diameter were treated ureteroscopically. Chronic urinary infections that were problematic preoperatively completely resolved after therapy. All 12 patients who had large bladder calculi with a mean diameter of 55.8 mm were treated to completion in one sitting.
Holmium laser energy is uniquely suited to treat all urinary calculi safely and effectively.
在一个临床系列中研究钬激光能量作为内镜碎石器的安全性和有效性。
在两年期间，对尿路结石患者使用钬激光碎石器进行内镜治疗，并前瞻性收集数据。使用了最大输出功率为15瓦、25瓦和60瓦的钬激光。开发了各种用于特定应用的低水密度石英纤维传输系统。此外，采用了各种内镜和激光纤维的组合。
共治疗了63例患者的75颗结石。所有结石均通过内镜清除。不同结石成分（包括胱氨酸结石）的激光效率变化极小。34颗输尿管结石中的33颗（97%）一次治疗完成。29例肾结石负荷采用钬激光治疗，其中26例仅采用逆行方式治疗。在后者中，23例（88.5%）仅需一次治疗。本系列未出现钬激光能量导致的并发症，包括输尿管狭窄疾病。复杂、大结石负荷的患者治疗完成后无后遗症。可主动偏转的柔性输尿管镜与200微米光纤的组合有助于清除18颗下极肾盏结石。对3例平均直径为30毫米的部分鹿角形结石负荷患者进行了输尿管镜治疗。术前有问题的慢性尿路感染在治疗后完全缓解。所有12例平均直径为55.8毫米的大膀胱结石患者均一次治疗完成。
钬激光能量特别适合安全有效地治疗所有尿路结石。
