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摘要: 目的 探索超脉冲铥光纤激光(super pulse thulium fiber laser，SP-TFL)碎石体外环境下的碎石效率及热效应情况。方法 将BegoStones结石置于弯盘内固定。连接光纤与激光机器，光纤与结石平面接触进行碎石。三维步进电机速度为1 mm/s，激光激发时间为连续激发30 s，按照预先设计，三维步进电机运动轨迹为“之”字形路线。测量每次碎石的重量，每组实验进行10次，最终计算平均值。操作时频率或者激光能量其中一个条件固定不变，另一个条件逐步增加。激光能量及频率范围为0.8~2.0 J×8~30 Hz及0.1~0.3 J×100~300 Hz，脉宽为7 ms。测温实验：调节实验室温度为22 ℃，激光功率：10 W(10 Hz×1 J)、15 W(10 Hz×1.5 J)、20 W(10 Hz×2 J)、25 W(10 Hz×2.5 J)、30 W(10 Hz×3 J)和灌注速度：0、15、25、35 mL/min(灌注液：生理盐水，温度为24 ℃)。激光连续激发120 s，测温仪每秒记录1次温度，记录激光激发时的实时温度以及激光激发前后温度的差值，每组实验重复10次，最终记录平均值。结果 同一种结石成分，相同的碎石功率，不同的脉冲能量、碎石频率组合10 W(1.0 J×10 Hz vs 0.1 J×100 Hz)、12 W(1.2 J×10 Hz vs 0.1 J×120 Hz)、15 W(1.5 J×10 Hz vs 0.1 J×150 Hz)，而产生的碎石效率不同：10 W[(57.40±6.68) mg/min vs (19.98±2.29) mg/min]、12 W[(64.49±11.31) mg/min vs (24.59±0.40) mg/min]、15 W[(98.98±2.89) mg/min vs (34.74±1.69) mg/min]。当单脉冲能量为0.1 J固定时，随着碎石频率的增加为100 Hz、120 Hz、150 Hz、180 Hz时，相对应的功率为10 W、12 W、15 W、18 W，激光的碎石效率也相应增加(19.98±2.29) mg/min、(24.59±0.40) mg/min、(34.74±1.69) mg/min、(39.73±5.70) mg/min。当碎石频率固定为100 Hz时，随着脉冲能量的增加为0.1 J、0.2 J、0.3 J，激光的碎石效率也相应增加(19.98±2.29) mg/min、(38.92±0.11) mg/min、(62.32±18.27) mg/min。相同的碎石频率与脉冲能量组合，不同的结石成分所造成的碎石效率不同，“软结石”组>“硬结石”组(P < 0.05)。在灌注流量为15 mL/min，碎石功率为10 W、15 W时，平台期温度均为低于安全阈值。碎石功率在20 W、25 W、30 W时，平台期温度超过安全阈值43 ℃。在灌注流量为25 mL/min时，碎石功率为10 W、15 W、20 W、25 W时平台期温度均为低于安全阈值。只有碎石功率在30 W时，平台期温度超过安全阈值43 ℃。在灌注流量为35 mL/min时，所有功率下的平台期温度不超过安全阈值43℃。结论 初步的碎石体外实验研究结果显示，SP-TFL对结石具有良好的碎石效果，同时，为避免较高的热效应，在使用过程中应当选择其合适的灌注速度。Abstract: Objective To explore the lithotripsy efficiency and thermal effect of super-pulse thulium fiber laser lithotripsy(SP-TFL).Methods BegoStones were fixed in a curved disc. The optical fiber is connected with the laser machine, and the optical fiber is contacted with the stone plane for lithotripsy. The speed of the 3D stepper motor is 1mm/s, and the laser excitation time is 30s for continuous excitation. According to the pre-design, the motion path of the 3D stepper motor is a zigzag route. The weight of lithotripsies was measured each time, and the average value was calculated for each group of experiments 10 times. One condition, frequency or laser power, is fixed while the other condition increases. The laser energy and frequency range are 0.8-2.0 J×8-30 Hz and 0.1-0.3 J×100-300 Hz, and the pulse width is 7 ms. Temperature measurement experiment: adjust the laboratory temperature to 22 ℃, laser power: 10 W (10 Hz×1 J), 15 W (10 Hz×1.5J), 20 W (10 Hz×2 J), 25 W (10 Hz×2.5 J), 30 W (10 Hz×3 J) and irrigation rate: 0, 15, 25, 35 mL/min (irrigation liquid: normal saline solution at 24 ℃). Laser continuous excitation 120s, the thermometer recorded the temperature once per second, recorded the real-time temperature during laser excitation and the temperature difference before and after laser excitation, each group of experiments repeated 10 times, and finally recorded the average value.Results The same stone composition, the same lithotripsy power, the combination of different pulse energy and lithotripsy frequency 10 W (1.0 J×10 Hz vs 0.1 J×100 Hz), 12 W (1.2 J×10 Hz vs 0.1 J×120 Hz), 15 W (1.5 J×10 Hz vs 0.1 J×150 Hz) result in different lithotripsy efficiencies: 10W ([57.40±6.68] mg/min vs [19.98±2.29] mg/min), 12 W ([64.49±11.31] mg/min vs [24.59±0.40] mg/min), 15 W ([98.98±2.89] mg/min vs [34.74±1.69] mg/min). When the monopulse energy is fixed at 0.1J, the corresponding power are 10 W, 12 W, 15 W and 18 W as the frequency of lithotripsies increases by 100 Hz, 120 Hz, 150 Hz and 180 Hz, and the efficiency of laser gravel also increases correspondingly: (19.98±2.29) mg/min, (24.59±0.40) mg/min, (34.74±1.69) mg/min, (39.73±5.70) mg/min. When the frequency was fixed at 100 Hz, the efficiency of laser lithotripsies were increased by (19.98±2.29) mg/min, (38.92±0.11) mg/min and (62.32±18.27) mg/min with the increase of pulse energy of 0.1 J, 0.2 J and 0.3 J. With the combination of the same lithotripsy frequency and pulse energy, different stone components caused different lithotripsy efficiencies, "soft stone" group > "hard stone" group (P < 0.05). When the irrigation flow rate is 15 mL/min and the lithotripsies power are 10 W and 15 W, the plateau temperature is lower than the safety threshold. When the lithotripsies power are 20 W, 25 W, and 30 W, the plateau temperature exceeds the safety threshold of 43 ℃. When the irrigation rate is 25 mL/min, and the lithotripsies power are 10 W, 15 W, 20 W and 25 W, the platform temperature is lower than the safety threshold. Only when the lithotripsy power is 30 W, the plateau temperature exceeds the safety threshold of 43 ℃. When the irrigation flow rate is 35 mL/min, the plateau temperature under all powers does not exceed the safety threshold of 43 ℃.Conclusion Our preliminary in vitro study results of lithotripsy show that SP-TFL has a good lithotripsy effect on stones. Meanwhile, in order to avoid high thermal effect, the appropriate irrigation rate should be selected.
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Key words:
- super-pulse thulium laser /
- lithotripsy /
- lithotripsy efficiency /
- thermal effect
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表 1 “硬石头”高能低频碎石结果
mg/min，X±S 频率 能量/J 0.8 1.0 1.2 1.5 2.0 8 Hz 26.08±4.42 43.36±11.32 74.36±11.67 138.71±17.12 10 Hz 33.66±9.57 57.40±6.68 64.49±11.31 98.98±2.89 139.36±6.82 15 Hz 63.08±9.62 90.28±16.01 119.50±20.00 121.60±21.22 165.97±32.34 20 Hz 71.99±8.42 110.08±17.75 144.66±21.72 187.43±11.18 25 Hz 116.39±37.12 132.73±13.63 173.14±25.53 30 Hz 138.84±12.91 182.20±28.22 192.34±27.78 
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表 2 “硬石头”低能高频碎石结果mg/min，X±S
能量 频率/Hz 100 120 150 180 200 250 300 0.1 J 19.98±2.29 24.59±0.40 34.74±1.69 39.73±5.70 41.24±2.35 75.94±0.09 89.636±5.59 0.2 J 38.92±0.11 48.30±9.95 114.67±17.39 118.15±13.29 136.38±4.92 0.3 J 62.32±18.27 102.81±13.48 163.65±10.50
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表 3 “软石头”高能低频碎石结果
mg/min，X±S 频率 能量/J 0.8 1.0 1.2 1.5 2.0 8 Hz 40.39±2.41 61.98±1.65 88.94±2.91 168.31±5.00 10 Hz 52.34±6.28 71.82±1.24 80.31±0.86 118.23±2.94 156.34±5.11 15 Hz 76.51±5.24 106.20±5.51 152.37±2.48 142.87±9.64 182.32±7.24 20 Hz 79.16±4.43 127.90±3.59 168.57±10.83 204.29±7.49 25 Hz 133.14±5.58 147.79±3.23 198.64±8.17 30 Hz 153.65±5.00 237.13±10.61 221.89±7.61
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表 4 “软石头”低能高频碎石结果mg/min，X±S
能量 频率/Hz 100 120 150 180 200 250 300 0.1 J 32.64±10.40 36.50±2.62 38.70±10.79 55.01±2.05 61.45±2.84 86.35±1.00 101.46±1.89 0.2 J 60.05±4.63 75.64±2.91 108.35±5.19 152.72±6.76 176.32±8.34 0.3 J 80.20±1.43 125.98±4.62 181.27±3.52
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表 5 “硬石头”与“软石头”高能低频碎石结果比较
mg/min，X±S 频率 1.0 J 1.2 J 1.5 J 硬结石 软结石 P值 硬结石 软结石 P值 硬结石 软结石 P值 8 Hz 26.08±4.42 40.39±2.41 < 0.05 43.36±11.32 61.98±1.65 < 0.05 74.36±11.67 88.94±2.91 < 0.05 10 Hz 57.40±6.68 71.82±1.24 < 0.05 64.49±11.31 80.31±0.86 < 0.05 98.98±2.89 118.23±2.94 < 0.05 15 Hz 90.28±16.01 106.20±5.51 < 0.05 119.50±20.00 152.37±2.48 < 0.05 121.60±21.22 142.87±9.64 < 0.05 20 Hz 110.08±17.75 127.90±3.59 < 0.05 144.66±21.72 168.57±10.83 < 0.05 187.43±11.18 204.29±7.49 < 0.05 25 Hz 132.73±13.63 147.79±3.23 < 0.05 173.14±25.53 198.64±8.17 < 0.05 30 Hz 182.20±28.22 237.13±10.61 < 0.05 192.34±27.78 221.89±7.61 < 0.05
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表 6 在不同灌注流速时不同的碎石功率情况下的温度
℃，X±S 激光功率 15 mL/min 25 mL/min 35 mL/min 平台期平均温度 平台期温度波动范围 平台期平均温度 平台期温度波动范围 平台期平均温度 平台期温度波动范围 15 W 37.58±0.69 35.5~39.6 31.95±1.00 29.4~33.9 31.13±0.61 30.1~32.6 20 W 42.20±0.85 39.1~44.5 35.53±0.89 32.8~37.6 31.28±0.75 29.3~32.7 25 W 48.60±0.34 46.9~49.9 39.24±0.59 37.6~40.7 34.33±0.68 32.6~35.9 30 W 51.63±0.36 49.6~54.0 41.84±0.77 40.3~43.5 34.83±0.73 33.0~36.3
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[1] Fried NM, Irby PB. Advances in laser technology and fibre-optic delivery systems in lithotripsy[J]. Nat Rev Urol, 2018, 15(9): 563-573. doi: 10.1038/s41585-018-0035-8
[2] 付猛, 胡卫国, 李建兴, 等. 输尿管镜碎石取石术安全共识[J]. 现代泌尿外科杂志, 2020, 25(5): 385-391. doi: 10.3969/j.issn.1009-8291.2020.05.004
[3] Traxer O, Keller EX. Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium: YAG laser[J]. World J Urol, 2020, 38(8): 1883-1894. doi: 10.1007/s00345-019-02654-5
[4] Winship B, Wollin D, Carlos E, et al. The Rise and Fall of High Temperatures During Ureteroscopic Holmium Laser Lithotripsy[J]. J Endourol, 2019, 33(10): 794-799. doi: 10.1089/end.2019.0084
[5] 肖博, 曾雪, 李建兴. 铥激光碎石的研究进展与临床应用[J]. 微创泌尿外科杂志, 2022, 11(3): 205-208. https://www.cnki.com.cn/Article/CJFDTOTAL-WCMN202203012.htm
[6] Ventimiglia E, Doizi S, Kovalenko A, et al. Effect of temporal pulse shape on urinary stone phantom retropulsion rate and ablation efficiency using holmium: YAG and super-pulse thulium fibre lasers[J]. BJU Int, 2020, 126(1): 159-167. doi: 10.1111/bju.15079
[7] Panthier F, Doizi S, Lapouge P, et al. Comparison of the ablation rates, fissures and fragments produced with 150 μm and 272 μm laser fibers with superpulsed thulium fiber laser: an in vitro study[J]. World J Urol, 2021, 39(6): 1683-1691. doi: 10.1007/s00345-020-03186-z
[8] 杨国胜. 多种激光在经尿道前列腺手术中的应用经验[J]. 中华泌尿外科杂志, 2020, 41(6): 405-407. doi: 10.3760/cma.j.cn112330-20200325-00229
[9] Liang H, Liang L, Yu Y, et al. Thermal effect of holmium laser during ureteroscopic lithotripsy[J]. BMC Urol, 2020, 20(1): 69. doi: 10.1186/s12894-020-00639-w
[10] Fried NM. Thulium fiber laser lithotripsy: an in vitro analysis of stone fragmentation using a modulated 110-watt Thulium fiber laser at 1.94 microm[J]. Lasers Surg Med, 2005, 37(1): 53-58. doi: 10.1002/lsm.20196
[11] Scott NJ, Cilip CM, Fried NM. Thulium Fiber Laser Ablation of Urinary Stones Through Small-Core Optical Fibers[J]. IEEE J Sel Top Quantum Electron, 2009, 15(2): 435-440. doi: 10.1109/JSTQE.2008.2012133
[12] Traxer O, Rapoport LM, Tsarichenko DG, et al. V03-02 first clinical study on superpulse thulium fiber laser for lithotripsy[J]. J Urol, 2018, 199(4): e321-e322.
[13] 肖博, 胡卫国, 张鑫, 等. "粉末法"与"碎块法"对软性输尿管镜碎石手术的预后分析[J]. 临床泌尿外科杂志, 2018, 33(7): 520-522, 536. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2018.07.004
[14] 丁天福, 肖博, 黄忠月, 等. 国产超脉冲铥光纤激光碎石体外实验研究[J]. 现代泌尿外科杂志, 2022, 27(11): 917-921. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWK202211006.htm
[15] Taratkin M, Laukhtina E, Singla N, et al. Temperature changes during laser lithotripsy with Ho: YAG laser and novel Tm-fiber laser: a comparative in-vitro study[J]. World J Urol, 2020, 38(12): 3261-3266. doi: 10.1007/s00345-020-03122-1
[16] Aldoukhi AH, Ghani KR, Hall TL, et al. Thermal Response to High-Power Holmium Laser Lithotripsy[J]. J Endourol, 2017, 31(12): 1308-1312. doi: 10.1089/end.2017.0679
[17] 丁天福, 肖博, 曾雪, 等. 超脉冲铥光纤激光体外碎石术中光纤周围温度变化的研究[J]. 临床泌尿外科杂志, 2023, 38(1): 53-56, 62. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2023.01.012
[18] 熊星, 杨江根, 赵振伟, 等. 输尿管软镜碎石术中肾盂内压力监测的临床应用与观察[J]. 临床泌尿外科杂志, 2021, 36(7): 573-576. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2021.07.013
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