钬激光热效应的体外模型研究

An In Vitro Model of The Thermal Effect of Holmium Laser

【目的】输尿管镜下钬激光碎石术是目前输尿管结石腔内治疗的标准术式,钬激光在碎石的同时因热效应可能对输尿管造成损伤,为了研究不同功率配置的钬激光的热效应开展了本次研究。【方法】本次研究通过建立钬激光热效应体外模型进行研究。在手术室,恒定温度21℃,湿度60%,选用常见的钬激光设备,连接550μm的全新光导纤维,置入内径为10 mm的玻璃试管,并注入1 mL生理盐水,试管置于容积为300 mL的37℃温水中,并使用温度仪实时监测并记录光纤头周围2 mm水温及烧杯中水温。参数设定:共设定7组14种激光参数,持续激发120 s,反复进行3次,连续监测并记录钬激光周围的水温及烧杯中的水温。【结果】同等功率情况下,高频低能组最终达到的温度显著高于低频高能组,且随着功率的提升两组之间的温差逐渐变大。当功率为5 W时,低能高频组平台期的最高平均温度在(52.24±0.10)℃,而高能低频组的平台期最高平均温度为(50.67±0.04)℃。而当功率为20 W时,低能高频组平台期的最高平均温度在(75.71±0.12)℃,而高能低频组的平台期最高平均温度为(67.61±0.03)℃。两组之间的差异均具有统计学意义(P<0.05)。【结论】临床上输尿管镜碎石术常用的钬激光功率会产生明显的热效应,局部温度可导致输尿管的不可逆损伤,同等功率条件下选择高能低频功率配置较低能高频可显著减少热效应。

【Objective】Holmium laser lithotripsy with the ureteroscope is the standard operation for ureteral caculus.During the process of lithotripsy,the heat generated by the laser may damage the ureter.A research was set up to study the thermal effect of the Holmium laser of different power settings.【Methods】In the operation room,with a constant temperature of 21℃and a humidity of 60%,a 100 W Holmium laser generator was connected to a 550μm laser fiberand the fiber was put into a 10 mm inner diameter glass tube with 1 mL saline in it.The tube was put into a 300 mL beaker with water of a constant temperature of 37℃.A multilogger thermometerwas positioned with the probe 2 mm from the tip of the fiber and in the water surround the tube.7 groups and 14 different settings of laser parameters were fired 120 s for three times.【Results】With the same power,the high frequency-low energy group reached a higher temperature than the low frequency-high energy group.The higher the power was,the bigger the differences were.When the power was 5W,the high frequency-low energy group reached a highest mean temperature of(52.24±0.10)℃,while the low fre-quency-high energy group reached(50.67±0.04)℃.When the power was 20W,the high frequency-low energy group reached a highest mean temperature of(75.71±0.12)℃,while the low frequency-high energy group reached(67.61±0.03)℃.The differences between these two groups are significantly(P<0.05).【Conclusions】The clinical used Holmi-um of usual power have significant thermal effect,which can heat up the ureter and lead to thermal damage.With a same power,the low frequency-high energy power setting can reduce thermal effect.