高频率低能量钬激光功率设置在软性输尿管镜治疗肾结石中的临床应用

Clinical application research on high-frequency and low-energy holmium laser parameter setup on flexible ureteroscope in treatment of renal stones

目的探讨软性输尿管镜下钬激光碎石术治疗肾结石时,钬激光的最优参数设置。方法采用软性输尿管镜下钬激光碎石术治疗的肾结石患者289例。213例结石位于上盏、中盏或肾盂内,54例位于下盏,22例位于多个肾盏,均为单侧病变,结石直径为8~25 mm,平均直径(13.5±4.2)mm。术中根据结石硬度将钬激光功率设置为0.8~1.5 J/15~30 Hz(12~45 W)。在总功率一定时,将钬激光的参数设置为高频率和低能量,尽量将结石"粉末化"(即结石碎片直径<2 mm)。术后复查,如有直径>4 mm的结石碎片,则行二期软镜处理。结果 285例成功置入软性输尿管镜,总置镜成功率为98.6%(285/289),其中280例可行钬激光碎石治疗,总的结石清除率为98.9%(277/280)。手术时间(48.5±15.8)分钟,术后平均住院时间3.5天。27例(9.6%)患者术后出现Ⅰ~Ⅱ级并发症,无Ⅲ级及以上并发症发生。结论软性输尿管镜联合钬激光碎石是治疗肾结石安全有效的方法,采用合理的钬激光参数设置,可达到较高的结石清除率和较低的并发症发生率。

Objective To investigate the optimal power setting of holmium laser when using flexible ureteroscopy with holmium laser lithotripsy in treating renal stones. Methods A total of 289 patients with renal stones were treated with modular flexible ureteroscope combined with Holmium lithotripsy.There were 213 cases in middle,upper calyx and renal pelvic,54 cases in lower calyx,22 cases in mulitple calyxes. The calculi ranged from 8 to 25 mm（ 13. 5 ± 4. 2） mm. According to the stone hardness,the Holmium laser lithotripsy was performed at maximum power of 12 to 45 W（ 0. 8 - 1. 5 J/15 - 30 Hz）. When the total power was constant,the holmium laser parameter was set at high-frequency and low-energy to turn the stone to powder（ stone fragments less than 2 mm）. A second-stage retrograde flexible ureteroscopy were performed for patients with residual stone fragments were larger than 4 mm. Results The overall success rate of placing the flexible ureteroscope into the ureter and kidney was 98. 6%（ 285/289）. Of all the 285 cases,280 cases were treated with holmium laser lithotripsy. The stone free rate was 98. 9%（ 277/280）.The operative time was（ 48. 5 ± 15. 8） min,the patients were discharged from hospital in 2 - 5 days（ mean3. 5 days） after the operation. 27 patients（ 9. 6%） with mild complications（ Clavien-Dindo classification：gradeⅠ-Ⅱ）,no patient experienced a ≥Ⅲ Clavien grade complication. Conclusion Flexible ureteroscope with Holmium laser lithotripsy is effective and safe for treatment of renal stones. By using reasonable parameter setting and holmium laser lithotripsy method,the higher stone free rate and a lower complication can be achieved,which provides an ideal treatment option for renal stone.