背景:Thulium光纤激光(TFL)成为治疗泌尿系结石的钬:钇铝石榴石(Ho:YAG)激光的竞争对手。
目的:比较Ho:YAG和TFL激光碎石术治疗肾结石和输尿管结石的疗效。
方法:使用PubMed/Medline进行文献检索,Embase,和WebofScience数据库,以确定直到2023年5月发布的报告。遵循系统审查和荟萃分析指南的首选报告项目,以确定合格的研究。主要结果是比较Ho:YAG和TFL激光碎石术的无结石率(SFR)。
结果:11项研究符合我们的纳入标准,以及来自1286和880名患者的数据,分别,回顾了Ho:YAG和TFL激光碎石术。大多数研究包括输尿管镜检查(URS)和逆行肾内手术作为程序,两个包括经皮肾镜取石术,其中一个只包括URS。只有两项研究报告了儿科患者的结果。当不考虑残留片段时,TFL与较高的SFR(比值比[OR]1.84,95%置信区间[CI]:1.06-3.20;p=0.031)相关,但当SFR指的是片段的存在<3mm(OR2.48,95%CI:0.98-6.29;p=0.055),或仅考虑带有MOSES的Ho:YAG时(p=0.068)。根据石头的位置,对于肾(OR3.14,95%CI:1.69-5.86;p<0.001),但对于输尿管(p=0.8)结石,TFL与较高的SFR相关。TFL与术中并发症发生率较低相关(OR0.34,95%CI:0.19-0.63;p<0.001)。在主要(p=0.4)或总体(p=0.4)并发症发生率方面没有发现差异。手术时间(p=0.051),和激光时间(p=0.9)。
结论:TFL是治疗泌尿系结石的一种有前途的激光治疗方法,与Ho:YAG相比有一定的优势。需要进一步的高质量研究来证实这些发现并优化手术设置。
结果:使用thu光纤激光而不是钬:钇铝石榴石可以在位于肾脏而不是输尿管的结石中达到更高的无结石率。
BACKGROUND: Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium aluminum garnet (Ho:YAG) laser for the treatment of urinary stones.
OBJECTIVE: To compare the efficacy between Ho:YAG and TFL for laser lithotripsy of renal and ureteral stones.
METHODS: A literature search was conducted using PubMed/Medline, Embase, and Web of Science databases to identify reports published until May 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was to compare the stone-free rate (SFR) between Ho:YAG and TFL for laser lithotripsy.
RESULTS: Eleven studies met our inclusion criteria, and data from 1286 and 880 patients who underwent, respectively, Ho:YAG and TFL laser lithotripsy were reviewed. Most studies included ureteroscopy (URS) and retrograde intrarenal surgeries as procedures, two included percutaneous nephrolithotomy, and one included URS exclusively. Only two studies reported results in pediatric patients. TFL was associated with a higher SFR (odds ratio [OR] 1.84, 95% confidence interval [CI]: 1.06-3.20; p = 0.031) when no residual fragment is considered, but not when SFR refers to the presence of fragments <3 mm (OR 2.48, 95% CI: 0.98-6.29; p = 0.055) or when only Ho:YAG with MOSES is considered (p = 0.068). According to the stones\' location, TFL was associated with higher SFRs than Ho:YAG for renal (OR 3.14, 95% CI: 1.69-5.86; p < 0.001) but not for ureteral (p = 0.8) stones. TFL was associated with a lower intraoperative complication rate (OR 0.34, 95% CI: 0.19-0.63; p < 0.001). No difference was found in major (p = 0.4) or overall (p = 0.4) complication rate, operative time (p = 0.051), and laser time (p = 0.9).
CONCLUSIONS: TFL is a promising laser for the treatment of urinary stones with some advantages over Ho:YAG. Further high-quality studies are needed to confirm these findings and optimize the surgical settings.
RESULTS: The use of thulium fiber laser rather than holmium:yttrium aluminum garnet permits to reach a higher stone-free rate in stones located in the kidney rather than in the ureter.