输尿管软镜钬激光碎石术中低温及常温灌注液效果的前瞻性随机对照研究  

A prospective, randomized controlled trial of hypothermic perfusion during flexible ureteroscopic holmium laser lithotripsy

作　　者：张伟 卢勇[1] 王彦波[1] 林楚琪 Zhang Wei;Lu Yong;Wang Yanbo;Lin Chuqi(Department of Urology,Jieyang People’s Hospital,Jieyang,Guangdong 522000)

机构地区：[1]揭阳市人民医院泌尿外科,广东522000

出　　处：《中华腔镜泌尿外科杂志（电子版）》2021年第3期229-232,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：2019揭阳市科技计划项目(2019ws013)。

摘　　要：目的研究低温灌注减少输尿管软镜钬激光碎石术中激光热损伤的效果。方法将拟行输尿管软镜碎石术的患者随机分为四组:组一常温(25℃)盐水灌注,碎石功率为15 W;组二低温(5℃)盐水灌注,碎石功率为15 W。组三常温(25℃)盐水灌注,碎石功率为30 W。组四低温(5℃)盐水灌注,碎石功率为30 W。在手术过程中测量输尿管软镜鞘的盐水温度,并记录手术时间。结果同等功率情况下,降低灌注液温度,回流液温度随之降低(P<0.05)。同样灌注液温度的情况下,高功率激光(30 W)比低功率激光碎石效率高(P<0.05),但增加了钬激光热损伤的风险。低温高功率组与常温低功率组的比较可见,在增大激光功率的同时降低灌注液温度,可以同时达到提高碎石速度,缩短手术时间,并减少钬激光热损伤的效果。结论输尿管软镜钬激光碎石术中低温灌注可以有效减少热效应、减少热损伤。Objective To explore the effects of hypothermic perfusion during flexible ureteroscopic holmium laser lithotripsy.Methods Patients undergoing flexible ureteroscopy with holmium laser lithotripsy were randomly divided into four groups:patients in group℃were perfused with saline at room temperature(25℃)and treated with a lithotripsy power of 15 W,group℃:(5℃,15 W),group℃:(25℃,30 W),group℃:(5℃,30 W).The temperature of the reflux saline in the ureteral access sheath of the flexible ureteroscope was measured,and the operation time was recorded.Results Under the same power,when the temperature of the perfusate was lowered,the temperature of the reflux fluid decreased.With the same perfusate temperature,high-power laser lithotripsy(30 W)exhibited greater stone fragmentation efficacy.Compared group℃with group℃,increasing the laser power while decreasing the perfusate temperature increased the rate of lithotripsy,shortened operation time,and reduced the thermal damage caused by the holmium laser.Conclusion In the context of laser lithotripsy,hypothermic perfusion can effectively reduce thermal effects and thermal damage to the urinary system.

关 键 词：输尿管软镜 激光 热损伤 

分 类 号：R699.4[医药卫生—泌尿科学]