Impact of holmium laser settings and fiber diameter on stone fragmentation and endoscope deflection
Impact of holmium laser settings and fiber diameter on stone fragmentation and endoscope deflection
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DOI：
10.1089/end.1998.12.523
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发表时间：
1998-12-01
影响因子：
2.7
通讯作者：
Preminger, GM
中科院分区：
文献类型：
--
作者：
Kuo, RL;Aslan, P;Preminger, GM
我们比较了不同能量设置、频率和光纤直径对钬激光碎石能力的影响。由巴黎石膏制成的重量均匀的石头模型用两种激光纤维尺寸之一处理：小（200和365 μ m）和大（550和1000 μ m）。将结石浸入水中，并在0.5、1.0或2.0 J和5、10或15 Hz下破碎3分钟。采用单因素方差分析比较两组的平均体重下降百分比。在两种不同的输尿管肾镜上测试了小纤维对输尿管肾镜偏转的影响。当使用小纤维时，增加能量水平导致更多的体重减轻（P < 0.05）。将频率增加到10 Hz也导致重量损失的显著增加（P < 0.05），但高于10 Hz，对于任一小纤维都没有观察到显著的额外重量损失。除非能量设置>1.0 J，否则两种纤维产生的重量损失没有显著差异。对大纤维的研究表明了类似的结果，随着能量的增加，重量损失显著增加（P < 0.05），而两种纤维直径的差异不显著。将激光频率增加到15 Hz导致大纤维的重量损失显著增加。200 μ m和365 μ m纤维的输尿管肾镜偏转损失分别为7%至16%和18%至37%。小直径纤维，结合半刚性或柔性输尿管镜，应用于治疗上尿路结石。365 μ m光纤应用于输尿管结石的管理，因为进入这些结石需要最小的内窥镜偏转。由于200 μ m光纤相当昂贵，它们的使用应保留用于肾内结石的破碎，其中在柔性输尿管肾镜检查期间需要最大偏转。小纤维的理想能量和频率设置为
We compared the impact of various energy settings, frequency, and fiber diameters on the stone fragmentation capabilities of the holmium laser. Stone phantoms, made from plaster of Paris and uniform in weight, were treated with one of two laser fiber sizes: small (200 and 365 mu m) and large (550 and 1000 mu m). Stones were immersed in water and fragmented for 3 minutes at 0.5, 1.0, or 2.0 J and 5, 10, or 15 Hz. The mean percentage decrease in weight in the two groups was compared using one-way ANOVA. The effect on flexible ureterorenoscope deflection of the small fibers was tested in two different ureterorenoscopes. Raising the energy level when using the small fibers resulted in more weight loss (P < 0.05). Increasing the frequency up to 10 Hz also resulted in a significant increase in weight loss (P < 0.05), yet above 10 Hz, there was no significant additional weight loss noted for either small fiber. There was no significant difference in the weight loss produced by the two fibers unless the energy setting was >1.0 J. Studies with the large fibers demonstrated similar results, with significant increments of weight loss occurring with increased energy (P < 0.05), while nonsignificant differences were seen for the two fiber diameters. Increasing laser frequency up to 15 Hz resulted in a significant increase in weight loss for the large fibers. Loss of ureterorenoscope deflection ranged from 7% to 16% and 18% to 37% for the 200-mu m and 365-mu m fibers, respectively. Small-diameter fibers, in combination with semirigid or flexible ureteroscopes, should be used to treat upper urinary tract stones. The 365-mu m fiber should be utilized for the management of ureteral stones, as minimal endoscopic deflection is required to access these calculi. Because the 200-mu m fibers are considerably more expensive, their use should be reserved for fragmentation of intrarenal calculi, where maximum deflection is required during flexible ureterorenoscopy. The ideal energy and frequency settings for the small fibers are