超脈沖光纖銩激光碎石的研究進展

Research progress of super-pulse fiber thulium laser lithotripsy

DING Tianfu，HUANG Zhongyue，XU Zheng，LI Jianxing

（Department of Urology，Beijing Tsinghua Changgung Hospital，Tsinghua University School of Clinical Medicine，Beijing 102218，China）

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 “l(fā)ow 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.

KEY WORDS：super-pulse fiber thulium laser; stone; lithotripsy; temperature

摘要：超脈沖光纖銩激光（以下簡稱銩激光）作為新型激光在醫(yī)學(xué)研究中展現(xiàn)出廣闊的應(yīng)用前景，尤其在處理泌尿系結(jié)石方面表現(xiàn)突出。銩激光光纖直徑更細，減少了工作通道的占用，增加了灌注水流，目前峰值功率高達500 W、單脈沖能量高達6 J、頻率高達2000 Hz。銩激光的碎石機制為光熱機制和光機械機制，不同的能量和頻率組合會顯著影響結(jié)石碎塊的體積，“高能低頻”更適合“碎塊化”碎石，而“低能高頻”更適合“粉末化”碎石。一些體外實驗已證實銩激光較鈥激光的碎石效率更高、結(jié)石位移更少、熱效應(yīng)更明顯。臨床上已將銩激光應(yīng)用于輸尿管鏡碎石取石術(shù)和經(jīng)皮腎鏡碎石術(shù)，且結(jié)石清除率及安全性均較高。本文從銩激光的碎石原理、體外實驗及臨床應(yīng)用等方面進行綜述，以期為未來超脈沖光纖銩激光的發(fā)展和應(yīng)用提供更好的理論支持和實踐經(jīng)驗。

關(guān)鍵詞：超脈沖光纖銩激光；結(jié)石；碎石；溫度

中圖分類號：R691.4"" 文獻標志碼：A

DOI：10.3969/j.issn.1009-8291.2025.01.016

收稿日期：2024-03-15""" 修回日期：2024-06-04

通信作者：

李建興，主任醫(yī)師。E-mail：ljx1@sina.com

作者簡介：

丁天福，博士研究生，住院醫(yī)師。研究方向：結(jié)石的微創(chuàng)治療。E-mail：dtf20@tsinghua.org.cn

隨著醫(yī)療技術(shù)的發(fā)展，激光作為碎石手術(shù)最常用的工具也得到了長足的發(fā)展。超脈沖光纖銩激光（以下簡稱“銩激光”）

作為一種新型激光技術(shù)，波長1940 nm，更接近于水吸收高峰，因此在水中的吸收系數(shù)更高，是波長2100 nm鈥激光的4倍以上，在碎石領(lǐng)域具有廣闊的應(yīng)用前景。目前鈥激光被國內(nèi)外指南推薦，應(yīng)用較廣泛，碎石效率高，而銩激光不僅具有比鈥激光更高的碎石效率，還具有較低的結(jié)石回退力、較細的光纖直徑等，在泌尿系結(jié)石的治療方面有著極大的潛力。……