In vitro experimental study on the temperature variation around super-pulse fiber of thulium fiber laser lithotripsy with Needle-perc
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摘要: 目的 探究Needle-perc超脉冲光纤铥激光碎石过程中光纤周围温度变化的情况。方法 利用体外肾结石模型，由同一名医生行Needle-perc激光碎石术，采用2个测温探头置于激光光纤两侧2 mm处，实时进行检测并记录。保持实验室温度25 ℃左右。灌流液采用生理盐水，温度22 ℃左右。灌流速度：0、25、50、100 mL/min。碎石功率：8、10、12、15 W，参数组合：“高能低频”模式和“高频低能”模式。间断激发：激发15 s，间断5 s，每组实验周期为120 s；连续激发：连续激发120 s，每组实验重复10次，温度记录仪实时记录温度。结果 碎石功率为8、10、12、15 W时，灌流速度为0 mL/min时，温度超过安全阈值的时间分别是连续激发模式：23、18、13、9 s，间断激发模式：30、24、13、9 s。灌流速度为25、50、100 mL/min时，无论哪种激发模式，温度都没超过安全阈值。碎石功率为8、10、12、15 W，灌流速度25 mL/min时，“高能低频”碎块化模式和“高频低能”粉末化模式光纤周围温度变化值相比较，“高频低能”温度变化值高于“高能低频”模式，差异有统计学意义(P < 0.05)。碎石功率为8、10、12、15 W，灌流速度25 mL/min时，连续激发和间断激发模式光纤周围温度变化值相比较，连续激发模式温度变化值温度高于间断激发，差异有统计学意义(P < 0.05)。结论 Needle-perc超脉冲光纤铥激光进行碎石时，连续激发模式温度变化值高于间断激发，“高频低能”参数组合温度变化值高于“高能低频”参数组合。但在碎石功率在≤15 W，灌注速度在≥25 mL/min时，无论哪种激发模式、参数组合，激光光纤周围的温度都是安全、可靠的。
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关键词:
- 肾结石 /
- Needle-perc /
- 温度 /
- 超脉冲铥激光
Abstract: Objective To investigate the temperature changes around the fiber during the Needle-perc ultra-pulse fiber thulium laser lithotripsy.Methods Using an in vitro kidney stone model, a single doctor performed Needle-perc laser lithotripsy, and two temperature probes were placed 2 mm on both sides of the laser fiber for real-time detection and recording. The laboratory temperature was maintained at around 25 ℃. The irrigation fluid was normal saline at a temperature of around 22 ℃. Irrigation flow rates were 0, 25, 50, and 100 mL/min. Lithotripsy power was set at 8, 10, 12, and 15 W, and parameter combinations were "high energy low frequency" mode and "high frequency low energy" mode. The excitation mode was intermittent excitation: excitation for 15 s, intermittent for 5 s, and the experimental period for each group was 120 s; continuous excitation: continuous excitation for 120 s. Each group of experiments was repeated 10 times, and the temperature recorder recorded the temperature in real time.Results If the lithotripsy power was 8, 10, 12, and 15 W and the irrigation flow rate was 0 mL/min, the time for the temperature to exceed the safety threshold in the continuous excitation mode was 23, 18, 13, and 9 s, respectively, and in the intermittent excitation mode, it was 30, 24, 13, and 9 s, respectively. If the irrigation flow rate was 25, 50, and 100 mL/min, no matter which excitation mode was used, the temperature did not exceed the safety threshold. If the lithotripsy power was 8, 10, 12, and 15 W and the irrigation flow rate was 25 mL/min, the temperature change value in the "high frequency low energy" mode was higher than that in the "high energy low frequency" mode. The difference was statistically significant(P < 0.05). If the lithotripsy power was 8, 10, 12, and 15 W and the irrigation flow rate was 25 mL/min, the temperature change value in the continuous excitation mode was higher than that in the intermittent excitation mode. The difference was statistically significant(P < 0.05).Conclusion During the Needle-perc super-pulse fiber thulium laser lithotripsy, the temperature change value in the continuous excitation mode is higher than that in the intermittent excitation mode, and the temperature change value in the "high frequency low energy" parameter combination is higher than that in the "high energy low frequency" parameter combination. However, if the lithotripsy power is ≤15 W and the irrigation flow rate is ≥25 mL/min, no matter which excitation mode or parameter combination is used, the temperature around the laser fiber is safe and reliable.-
Key words:
- kidney stones /
- Needle-perc /
- temperature /
- super-pulse thulium laser
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表 1 碎石功率与激发模式在0 mL/min灌流下温度超阈值时间比较
s 流速 碎石功率 激发模式 8 W 10 W 12 W 15 W 0 mL/min 23.00±0.67 18.00±0.12 13.00±0.62 9.00±0.63 连续 30.00±0.34 24.00±0.83 13.00±0.62 9.00±0.63 间断 25 mL/min - - - - 连续 - - - - 间断 50 mL/min - - - - 连续 - - - - 间断 100 mL/min - - - - 连续 - - - - 间断 注：“-”表示温度未达到安全阈值。 
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表 2 超脉冲铥激光碎石功率与碎石模式在25 mL/min灌流下连续激发120 s时光纤周围温度变化的比较
℃ 模式 碎石功率 8 W 10 W 12 W 15 W 高能低频 2.10±0.14 2.54±0.36 2.98±0.05 3.46±0.16 高频低能 2.92±0.35 3.04±0.49 3.58±0.56 4.01±0.37 t -6.88 -2.6 -3.38 -4.32 P值 ＜0.001 0.01 ＜0.001 ＜0.001
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表 3 超脉冲铥激光碎石功率与激发模式在高能低频模式下25 mL/min灌注时光纤周围温度变化的比较
℃ 模式 碎石功率 8 W 10 W 12 W 15 W 连续激发 2.10±0.14 2.54±0.36 2.98±0.05 3.46±0.16 间断激发 1.32±0.35 1.54±0.27 1.83±0.23 2.23±0.38 t 6.54 0.14 15.45 9.43 P值 ＜0.001 0.01 ＜0.001 ＜0.001
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