超脉冲光纤铥激光碎石的研究进展

Research progress of super-pulse fiber thulium laser lithotripsy

摘要

超脉冲光纤铥激光（以下简称铥激光）作为新型激光在医学研究中展现出广阔的应用前景，尤其在处理泌尿系结石方面表现突出。铥激光光纤直径更细，减少了工作通道的占用，增加了灌注水流，目前峰值功率高达 500 W、单脉冲能量高达 6 J、频率高达 2000 Hz。铥激光的碎石机制为光热机制和光机械机制，不同的能量和频率组合会显著影响结石碎块的体积，“高能低频”更适合“碎块化”碎石，而“低能高频”更适合“粉末化”碎石。一些体外实验已证实铥激光较钬激光的碎石效率更高、结石位移更少、热效应更明显。临床上已将铥激光应用于输尿管镜碎石取石术和经皮肾镜碎石术，且结石清除率及安全性均较高。本文从铥激光的碎石原理、体外实验及临床应用等方面进行综述，以期为未来超脉冲光纤铥激光的发展和应用提供更好的理论支持和实践经验。

Abstract

Super-pulse thulium fiber laser (hereinafter referred to as thulium laser) has shown broad application prospects in medical research, especially in the treatment of urinary tract stones. Thulium laser has a thin fiber diameter, which reduces the occupation of the working channel and increases the irrigation water flow. Currently, the peak power reaches up to 500 W, the single pulse energy to 6 J, and the frequency to 2000 Hz. The stone-breaking mechanism of thulium laser is photothermal and photomechanical. Different combinations of energy and frequency will significantly affect the volume of stone fragments. “High energy and low frequency” is more suitable for “fragmentation” stone breaking, while “low energy and high frequency” is more suitable for “powderization” stone breaking. Some in vitro experiments have confirmed that thulium laser has higher stone-breaking efficiency, less stone displacement, and more obvious thermal effects compared to holmium laser. Clinically, thulium laser has been applied to ureteroscopic lithotripsy and percutaneous nephrolithotomy, and the stone free rate and safety are relatively high. This article reviews the stone-breaking principles, in vitro experiments, and clinical applications of thulium laser, aiming to provide better theoretical support and practical experience for the development and application of super-pulse thulium fiber laser in the future.

关键词

超脉冲光纤铥激光 / 结石 / 碎石 / 温度

Key words

super-pulse fiber thulium laser / stone / lithotripsy / temperature

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