Holmium:YAG Laser Pulse Type Affects Irrigation Temperatures in a Benchtop Ureteral Model.
Holmium:YAG Laser Pulse Type Affects Irrigation Temperatures in a Benchtop Ureteral Model.
复制标题
钬:YAG 激光脉冲类型影响台式输尿管模型中的冲洗温度。
作者：
Brenton B. Winship;R. Terry;Kohldon Boydston;Evan C. Carlos;D. Wollin;C. Peters;Jingqiu Li;G. Preminger;M. Lipkin
简介
MOSES™ 技术是一种钬：YAG 激光脉冲模式，可最大限度地减少结石的后推力。这可以有利于在较高功率设置下进行碎石术。然而，功率和热量产生是成正比的，输尿管镜碎石术期间可能会出现能够造成组织损伤的温度。虽然之前的体外研究证明了冲洗和激活时间对产热的重要性，但脉冲类型的影响尚未得到评估。
方法
将带有 365μm 激光纤维的输尿管软镜置于插入 250cmL 盐水袋的 11/13Fr 通路鞘中，以模拟输尿管、肾盂和顺行冲洗液流。将热电偶放置在激光尖端附近，激光在 100mmHg 的冲洗压力下以 0.6J/6Hz、0.8J/8Hz、1J/10Hz、1J/20Hz 和 0.2J/70Hz 发射 30 秒。每个设置使用短脉冲 (SP)、长脉冲 (LP)、MOSES 接触 (MC) 和 MOSES 距离 (MD) 模式测试 4 次运行。比较平均温度变化 (dT)，并使用调整后的 37°C 基线以 43°C 下的累积等效分钟数 (CEM43) 计算热剂量。 CEM43≥120分钟被认为是组织损伤阈值。
结果
在0.8J/8Hz处，LP产生最大的dT，显着高于MC(p=0.041)。 CEM43没有超过损伤阈值。在 1J/10Hz 时，LP 的 dT 显着高于 MC 和 MD（p=0.024、0.045）。热剂量仍低于损伤阈值。 0.6J/6Hz、0.2J/70Hz 或 1J/20Hz 的脉冲类型之间的 dT 没有差异。在 1J/20Hz 下，热剂量在 3 秒内超过所有脉冲类型的损伤阈值。
结论
激光脉冲类型和长度似乎会影响我们输尿管模型中的热量产生。相对于 MOSES™ 设置，长脉冲在 0.8J/8Hz 和 1J/10Hz 时产生明显更高的温度。幸运的是，在这些设置下热剂量仍然是安全的。众所周知，长脉冲和 MOSES™ 技术都可以减少结石的后推力；后者可以通过减少热量来实现这一优点。
INTRODUCTION
MOSES™ technology is a Holmium:YAG laser pulse mode shown to minimize stone retropulsion. This may facilitate lithotripsy at higher power settings. However, power and heat production are proportional, and temperatures capable of tissue injury may occur during ureteroscopic lithotripsy. While prior in vitro studies demonstrate the importance of irrigation and activation time on heat production, the impact of pulse type has not been evaluated.
METHODS
A flexible ureteroscope with a 365μm laser fiber was placed in an 11/13Fr access sheath inserted into a 250cmL saline bag to simulate a ureter, renal pelvis, and antegrade irrigant flow. A thermocouple was placed adjacent to the laser tip, and the laser fired for 30 sec at 0.6J/6Hz, 0.8J/8Hz, 1J/10Hz, 1J/20Hz, and 0.2J/70Hz at irrigation pressure of 100mmHg. 4 runs were tested per setting using short pulse(SP), long pulse(LP), MOSES-contact(MC) and MOSES-distance(MD) modes. The mean temperature changes(dT) were compared and thermal dose calculated in Cumulative Equivalent Minutes at 43°C(CEM43) using an adjusted baseline of 37°C. CEM43 ≥120 minutes was considered the tissue injury threshold.
RESULTS
At 0.8J/8Hz, LP produced the greatest dT, significantly higher than MC(p=0.041). CEM43 did not exceed the injury threshold. At 1J/10Hz, dT was significantly higher for LP versus MC and MD(p=0.024, 0.045). Thermal dose remained below the injury threshold. No differences in dT were seen between pulse types at 0.6J/6Hz, 0.2J/70Hz, or 1J/20Hz. At 1J/20Hz, thermal dose exceeded the injury threshold for all pulse types within 3 seconds.
CONCLUSIONS
Laser pulse type and length appears to impact heat production in our ureteral model. Long pulse produced significantly greater temperatures at 0.8J/8Hz and 1J/10Hz relative to MOSES™ settings. Fortunately, thermal dose remained safe at these settings. Both long pulse and MOSES™ technology are known to reduce stone retropulsion; the latter may confer this advantage with reduced heat.
DOI：
10.1016/0360-3016(84)90379-1
发表时间：
1984-01-01
影响因子：
7
作者：
SAPARETO, SA;DEWEY, WC
通讯作者：
DEWEY, WC