钬激光在泌尿系腔道模型中热效应的实验研究  

Thermal effects of holmium laser in endourological in-vitro model

作　　者：蒋双键 莫承强[1] 桂程鹏 唐一鸣 潘金成[1] 吴荣佩[1] Jiang Shuangjian;Mo Chengqiang;Gui Chengpeng;Tang Yiming;Pan Jincheng;Wu Rongpei(Department of Urology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院泌尿外科,广州510080

出　　处：《中华泌尿外科杂志》2021年第3期220-225,共6页Chinese Journal of Urology

摘　　要：目的观察钬激光在泌尿系腔道模型中的局部热效应。方法本研究于2019年3—12月进行。建立静态介质模型:在常压、25℃恒温、50%湿度的环境下,将内径为1 cm、装有1 ml工作介质的玻璃试管置入300 ml 37℃恒温水浴烧杯中,将550μm激光光纤置入试管内工作介质中,连续激发激光60 s。利用电子温度测定仪连续记录试管内水温变化。激光工作模式分别设置为粉末化、碎块化、"爆米花"模式,功率设置为10~20 W,工作介质分别为生理盐水、蒸馏水、5%甘露醇溶液,记录不同模式、不同介质光纤周围温度变化。建立流动介质模型:在常压、25℃恒温、50%湿度的环境下,将相同光纤和温度探头置入内径为6 mm冲洗管,以生理盐水持续灌流,灌流量为100~1200 ml/h。记录不同灌流量下激光发射期间局部水温变化。分析不同模式、不同介质、不同灌流量光纤周围实时温度变化情况。结果在工作介质为生理盐水的静态介质模型中,钬激光连续激发(6.0±1.2)s即超过43℃安全温度,激发(27.6±2.1)s达到平台期温度,停止激发后(38.2±2.4)s可降至安全温度;平台期温度粉末化组>"爆米花"组>碎块化组(P<0.01),其中20 W粉末化组最高,为(78.67±0.45)℃,10 W碎块化组最低,为(55.67±0.22)℃。在静态介质模型中,以5%甘露醇溶液作为工作介质的平台期温度[(73.92±0.44)℃]较蒸馏水组[(75.57±0.14)℃]和生理盐水组[(78.67±0.45)℃]低(粉末化模式,20 W)。在流动介质模型中,灌流量达到800 ml/h时,连续激发钬激光即可保持在安全温度(40.96±0.36)℃,停止激发后仅需(7.0±1.0)s降至初始温度。结论钬激光在相同的总功率下,碎块化模式热效应相对较低;相同总功率时,5%甘露醇溶液环境下钬激光激发时的热效应较低;≥800 ml/h的灌流量,可以有效降低钬激光热效应导致的局部高温。Objective To simulate the urinary tract environment in vitro and observe the local thermal effects generated by the holmium laser when it is continuously emitting under different mode settings,working medium and perfusion speed.Methods This study was conducted from March to December 2019.Static medium model:Under normal pressure,25℃constant temperature and 50%humidity,a glass test tube with an inner diameter of 1cm and working medium of 1ml was placed into a beaker containing 300ml of 37℃constant temperature water,and a 550μm laser fiber was placed in the working medium in the test tube.The laser was continuously emitting for 60.0 seconds,and the temperature of the water in the test tube was continuously recorded using a temperature measuring instrument.The laser working mode was set as dusting,fragmenting,and"popcorn"mode,the energy was set at 10-20 W,and the working medium was normal saline,distilled water,and 5%mannitol solution.Flow medium model:In the same environment,the same optical fiber and temperature probe were placed in a 6mm flush tube,and the laser was continuously fired and continuously perfused with saline.The flushing speed was controlled between 100 ml/h and 1200 ml/h,and the water temperature change during laser emission was recorded.The real-time temperature changes around the fiber tip with different modes,different media,and different perfusion rates were analyzed.Results Static medium model:After the holmium laser was continuously fired for about 6.0±1.2 seconds,it exceeded the safe temperature of 43℃,reached the plateau temperature in about 27.6±2.1 seconds and drop to the safe temperature after stopping excitation for 38.2±2.4 seconds.The plateau temperature dusting group>"popcorn"group>fragmenting group(P<0.01),of which the dusting group(78.67±0.45)℃(20 W)was the highest and the fragmenting group(55.67±0.22)℃(10 W)was the lowest.The temperature of 5%mannitol solution(73.92±0.44)℃was the lowest among the three experimental working media,which was(75.57±0.14)℃of disti

关 键 词：激光 钬 热效应 工作模式 介质 灌流量 

分 类 号：R699[医药卫生—泌尿科学]