Vassar G J, Teichman J M, Glickman R D
Department of Ophthalmology, University of Texas Health Science Center, San Antonio, USA.
J Urol. 1998 Aug;160(2):471-6. doi: 10.1016/s0022-5347(01)62927-6.
We test the hypothesis that holmium:YAG lithotripsy efficiency varies with optical fiber size and energy settings (energy density).
The 272, 365, 550 and 940 microm. optical fibers delivered 1 kJ. total holmium:YAG energy to calcium oxalate monohydrate calculi at energy output/pulse of 0.2 to 1.5 J. Stone mass loss was measured for each fiber energy setting. Stone crater width was characterized for single energy pulses. Fiber energy outputs were compared before and after lithotripsy.
Stone mass loss correlated inversely with optical fiber diameter (p <0.05). Stone loss correlated with energy/pulse for the 365, 550 and 940 microm. fibers (p <0.001). The 272 and 365 microm. fibers yielded equivalent stone loss at 0.2 and 0.5 J. per pulse. At energies of 1.0 J. per pulse or greater the 272 microm. optical fiber was prone to damage, and yielded reduced energy output and stone loss compared to the 365 microm. fiber (p <0.01). Stone crater width for single pulse energies correlated with energy settings for all fibers (p <0.001).
Lithotripsy efficiency with the holmium:YAG laser depends on pulse energy output and diameter of the optical delivery fiber, implying that lithotripsy efficiency correlates with energy density. The 365 microm. fiber is indicated for most lithotripsy applications. The 272 microm. fiber is susceptible to damage and inefficient energy transmission at energies of 1.0 J. per pulse or greater. The 272 microm. fiber is indicated at energies of less than 1.0 J. per pulse for small caliber ureteroscopes or when maximal flexible ureteroscope deflection is required.
我们检验钬激光碎石效率随光纤尺寸和能量设置（能量密度）而变化的假说。
272、365、550和940微米的光纤在0.2至1.5焦耳的能量输出/脉冲下，向一水草酸钙结石输送1千焦的总钬激光能量。测量每种光纤能量设置下结石的质量损失。对单个能量脉冲的结石凹坑宽度进行表征。比较碎石前后的光纤能量输出。
结石质量损失与光纤直径呈负相关（p<0.05）。结石损失与365、550和940微米光纤的能量/脉冲相关（p<0.001）。272和365微米的光纤在0.2和0.5焦耳/脉冲时产生的结石损失相当。在1.0焦耳/脉冲或更高能量时，272微米的光纤易于损坏，与365微米的光纤相比，其能量输出和结石损失降低（p<0.01）。所有光纤的单个脉冲能量的结石凹坑宽度与能量设置相关（p<0.001）。
钬激光碎石效率取决于脉冲能量输出和光导纤维的直径，这意味着碎石效率与能量密度相关。365微米的光纤适用于大多数碎石应用。272微米的光纤在1.0焦耳/脉冲或更高能量时易受损且能量传输效率低。对于小口径输尿管镜或需要最大程度的输尿管软镜偏转时，272微米的光纤适用于低于1.0焦耳/脉冲的能量。
