Abstract：
Objectives: The super-pulsed thulium fiber laser (SP TFL) is a new alternative to high-power holmium laser for intracorporeal lithotripsy. The SP TFL has shown advantages in dusting regimes, but benefits in fragmentation regimes are less understood. The second-generation SP TFL introduces an advanced fragmentation pulse (AFP) sequence to maximize SP TFL\'s efficiency in fragmentation. This study evaluates safety and efficacy of the SP TFL fragmentation mode in ureteroscopy (URS) and mini percutaneous nephrolithotomy (mini-PCNL). Materials and Methods: The study was conducted in two phases. Safety of a new AFP was compared ex vivo to standard SP TFL fragmentation settings by measuring the dimensions of wounds created in porcine kidney after laser exposure for 0.5, 1.0, and 2.0 s. The resulting wounds were evaluated histologically using nitro blue tetrazolium chloride (NBTC) stain. In the clinical phase, the second-generation SP TFL was used to fragment and extract ureteral and renal stones in 40 patients using ureteroscopic and percutaneous approaches. The stone size, volume, density, laser-on-time, and total energy were recorded for each patient. In addition, the chemical composition, ablation rate, and ablation efficiency were assessed for each stone treatment. Results: The ex vivo mucosa damage profiles caused by AFP were similar to those caused by regular pulses. In clinical phase, the median volume and density for ureteral stones were 0.4 cm3 and 1029 Hounsfield units (HU), for renal stones 1.3 cm3 and 1113 HU, respectively. Different stone types were crushed into fragments suitable for extraction. The mean AFP energy was 3 J and the average power for ureteral stones was 10.5 W, whereas for renal stones it was 28.5 J and 31 W, respectively. The overall complication rate was low in both groups. Conclusion: ST PFL with AFP capability facilitates effective fragmentation of ureteral and renal stones of any composition during URS and mini-PCNL with minimal complication rates.
摘要：
目的：超脉冲thus光纤激光（SPTFL）是高功率钬激光体外碎石术的新替代方法。SPTFL在除尘方案中显示出优势，但是人们对碎片化制度的好处知之甚少。第二代SPTFL引入了先进的分段脉冲（AFP）序列，以最大程度地提高SPTFL的分段效率。这项研究评估了URS和mini-PCNL中SPTFL片段化模式的安全性和有效性。
方法：本研究分两个阶段进行。通过测量激光暴露0.5、1.0和2.0秒后在猪肾中产生的伤口的尺寸,将新AFP的安全性与标准SPTFL碎片设置进行体外比较。使用NBTC(氯化硝基蓝四唑)染色对所得伤口进行组织学评价。在临床阶段，使用第二代SPTFL对40例患者进行输尿管镜和经皮入路切开和取出输尿管和肾结石.石头的大小,volume,密度,激光接通时间,记录每位患者的总能量。此外,化学成分,消融率,评估每次结石治疗的消融效率。
结果：由AFP引起的离体粘膜损伤谱与由规则脉冲引起的类似。在临床阶段，输尿管结石的中位体积和密度分别为0.4cm3和1029HU，对于肾结石-1.3cm3和1113HU，分别。将不同类型的石头压碎成适合提取的碎片。平均AFP能量为3J，输尿管结石的平均功率为10.5W，而对于肾结石，它是28.5J和31W，分别。两组的总并发症发生率均较低。
结论：具有AFP能力的STPFL有助于在URS和mini-PCNL期间有效碎裂输尿管和肾结石，并发症发生率最低。
方法：本研究分两个阶段进行。通过测量激光暴露0.5、1.0和2.0秒后在猪肾中产生的伤口的尺寸,将新AFP的安全性与标准SPTFL碎片设置进行体外比较。使用NBTC(氯化硝基蓝四唑)染色对所得伤口进行组织学评价。在临床阶段，使用第二代SPTFL对40例患者进行输尿管镜和经皮入路切开和取出输尿管和肾结石.石头的大小,volume,密度,激光接通时间,记录每位患者的总能量。此外,化学成分,消融率,评估每次结石治疗的消融效率。
结果：由AFP引起的离体粘膜损伤谱与由规则脉冲引起的类似。在临床阶段，输尿管结石的中位体积和密度分别为0.4cm3和1029HU，对于肾结石-1.3cm3和1113HU，分别。将不同类型的石头压碎成适合提取的碎片。平均AFP能量为3J，输尿管结石的平均功率为10.5W，而对于肾结石，它是28.5J和31W，分别。两组的总并发症发生率均较低。
结论：具有AFP能力的STPFL有助于在URS和mini-PCNL期间有效碎裂输尿管和肾结石，并发症发生率最低。
