【摘要】 目的 :研究大功率 ( 60 W以上 )钬激光粉碎结石的性能及其有效合理的碎石参数。方法 :1体外实验 :将 12枚泌尿系结石 (结石成分为尿酸结石、草酸结石、磷酸结石 ,大小 1.0～ 2 .0 cm)浸于生理盐水中 ,在不同钬激光参数设置下 ,用钬激光粉碎结石 (结石粉碎至 <0 .5mm) ,观察钬激光碎石能力、合理有效的参数设置及对不同成分结石的碎石情况等。2临床应用 :经耻骨上穿刺 ,用大功率钬激光治疗膀胱结石 6例 ,结石成分为尿酸结石、草酸结石等 ,大小 1.0～ 3.0 cm,其中 1例并发膀胱肿瘤 (肿瘤直径约 1.0 cm)。结果 :钬激光可以粉碎所有 2 3枚结石 ,时间 2～ 2 0 min,其中尿酸结石最容易粉碎 ,且安全有效 ,术中无膀胱穿孔、膀胱出血等并发症 ,术后仅需留置导尿管 1～ 3d(甚至可以不留置导尿管 ) ,患者痛苦小 ,恢复快。对体外冲击波及腔内液电碎石无效的结石也可粉碎 ,且可一并切割、气化膀胱肿瘤。结论 :大功率钬激光可以粉碎不同成分的泌尿系结石 ,碎石效果确实 ,术中无并发症 ,患者无痛苦 ,操作技术简单。更多还原

【Abstract】 Purpose:To study capability of large power Ho:YAG laser (power > 60 watt) for lithotripsy and effective lithotripsy parameter to different stone composition. Methods: ① Experiment in vitro: Put 12 urinary stones (compositions: uric acid, calcium oxalate and calcium phosphate; size:1.0~2.0 cm) into normal saline, then use different parameter Ho:YAG laser to fragment them, observe the capability of lithotripsy and select good and effective parameter to different composition stones. ② Clinical application: Large power Ho:YAG laser was applied for endoscopic treating 6 cases (11 stones) of bladder calculus (composition: calcium phosphate, calcium oxalate, uric acid et al.; size:1.0～3.0 cm), one case had bladder tumor (diameter 1.0 cm) at same time. Results: All 23 stones could be fragmented within 2~20 minutes. The different composition calculi had different effective lithotripsy parameter (energy-pulse-power).The uric acid stone was easiest to be fragmented. There were no operative complication such as bladder perforation, bleeding and little distress to patients. It had advantages of easy operation, short hospitalization, short catheter time (1～2 days), even no catheter. It also could fragment calculi following failure of ESWL and electrohydraulic lithotripsy, and cut and vaporized bladder tumor at same time. Conclusions: Lager power Ho:YAG were able to fragment all kinds urinary stones. It was an effective, safe and simple treatment method for urinary calculus.更多还原