经输尿管镜钬激光碎石治疗输尿管结石

目的探讨经输尿管镜钬激光碎石治疗输尿管结石的临床效果. 方法 90例输尿管结石,经尿道、膀胱置入10°输尿管镜抵达结石处,将光纤头直抵结石,设置工作能量0.8～1.5 J,频率8～10 Hz,采用连续脉冲方式粉碎结石. 结果3例进镜失败(输尿管镜无法到达结石部位)改开放手术,1例输尿管穿孔改开放手术;86例碎石成功,单次钬激光碎石成功率为95.6%(86/90).手术时间30～80 min,平均55 min.术后住院1～5 d,平均2.5 d.86例随访1～3个月,69例病程＜6个月、肾积水＜4 cm,肾积水完全消失;17例病程＞6个月、肾积水＞4 cm,术后患肾均有不同程度积水,但较术前明显改善. 结论经输尿管镜钬激光碎石治疗输尿管结石效果理想,创伤小,并发症少,可作为输尿管中、下段结石的首选治疗方法.     

输尿管镜钬激光治疗输尿管纤维上皮息肉14例报告

目的：探讨输尿管镜钬激光治疗输尿管纤维上皮息肉的有效性和安全性。方法：应用输尿管镜钬激光技术治疗输尿管纤维上皮息肉患者14例，其中上段息肉10例，中、下段息肉各2例，并发输尿管结石9例。结果：术后随访3个月，12例疗效满意，肾积水明显改善．保护了肾功能；1例发生输尿管狭窄．1例残留结石。结论：输尿管镜钬激光技术是治疗输尿管纤维上皮息肉安全、有效的方法，但远期疗效尚需进一步研究。     

经尿道钬激光切除膀胱肿瘤(附20例报告)

目的探讨经尿道钬激光膀胱肿瘤切除术的临床疗效和安全性。方法对20例膀胱肿瘤（Ta～T2a期）经尿道钬激光膀胱肿瘤切除，其中17例为初发肿瘤，3例为复发肿瘤。激光功率15～40W。小的肿瘤（直径〈1.0cm，窄蒂）直接汽化，大的肿瘤（直径〉1．0cm，宽带）自瘤体基底部切除，再将其周围1～2cm正常组织汽化、烧灼。结果20例膀胱肿瘤均一次切除，手术时间10～70min（直径〉1．0cm，宽蒂），平均30min。术中无闭孔神经反射、膀胱穿孔及水中毒发生，无输血。术后保留导尿时间1～5d，平均3d。16例随访3个月，4例随访半年，平均3．6月，均未见肿瘤复发。结论经尿道钬激光膀胱肿瘤切除疗效确切、安全性高。     

The arthroscopic monopolar radiofrequency treatment of chronic anterior cruciate ligament instability

The Holmium:YAG (Ho:YAG) laser is the arthroscopic laser of choice. The arthroscopic surgeon can ablate, coagulate, or shrink periarticular soft tissues by manipulating Ho:YAG laser power settings. The ability to ablate soft tissue in a hemostatic fashion greatly facilitates the treatment of labral tear, synovitis, subacromial arch decompression, and distal clavicle arthritis. The nonablative application of Ho:YAG laser energy has been used successfully to treat glenohumeral instability. The laser-assisted capsular shift (LACS) procedure, in conjunction with standard labral repair techniques, successfully treats unidirectional and multidirectional shoulder instability Neuromuscular rehabilitation is accelerated. Excellent clinical results may be achieved with appropriate surgical technique and postoperative rehabilitation.     

Efficacy and safety of holmium laser enucleation of the prostate for elderly patients: surgical outcomes and King’s Health Questionnaire

BackgroundHolmium laser enucleation of the prostate (HoLEP) has been a widely utilized minimally invasive surgical procedure for benign prostate hyperplasia. The current study aimed to compare surgical outcomes and King’s Health Questionnaire (KHQ) assessment scores following HoLEP between younger men and those aged ≥75 years.MethodsThis prospective single-center study compared perioperative complications, postoperative urinary conditions, and KHQ scores (nine categories) between men aged ≥75 years (group A) and men aged <75 years (group B) before and 1, 3, and 6 months after surgery.ResultsA total of 100 patients were included for analysis (group A, n=38 and group B, n=62). No differences in patient backgrounds, perioperative complications, such as perioperative decrease in hemoglobin, postoperative fever, postoperative indwelling catheterization duration, or postoperative hospitalization duration, and KHQ were observed between both groups. Both groups showed significantly better International Prostate Symptom Scores, quality of life, maximum urinary flow rate, and postvoid residual volume 1, 3, and 6 months after HoLEP compared to their respective preoperative levels (P<0.01). Regarding KHQ categories, both groups showed significantly better general health perceptions, impact on life, emotions, and sleep/energy 1 month after HoLEP; role limitations, physical limitations, and social limitations 3 months after HoLEP; and personal relationships and incontinence severity measures 6 months after HoLEP compared to their respective preoperative levels (P<0.05).ConclusionsHoLEP could be safe and effective even for men aged ≥75 years, comparing complications, urinary condition, and KHQ scores.     

Holmium: YAG laser surgery in obliterated cochleas: an experimental study in human cadaver temporal bones

A pulsed holmium: YAG laser ( = 2120 nm) was used to reopen the basal turn of artificially obliterated human cochleas in freshly dissected cadavers. This allowed intracochlear insertion of the stimulation electrode of a cochlear implant under simulated surgical conditions. Laser energy was transmitted through a 400-m nylon fiber via the opened facial recess directly to the round window niche. At an energy level of 500 mJ per 2.5 s pulse, a repetition rate of 2 Hz, and an exposure time of 20–30 s, the photo-ablative mechanism of laser-bone interaction led to a 8–10 mm recanalization of the basal turn of the cochlea without damaging surrounding structures. The artificial bony occlusion and the recanalized basal turn of the cochlea were visualized by means of computed tomography and studied under light microscopy, using a histologic thin-section technique.Presented at the XVth World Congress of Otorhinolaryngology, Istanbul, Turkey, 23 June 1993     

Transurethral holmium laser resection of the prostate – progress in the treatment of BPH?

Summary After the initial enthusiasm subsided lasercoagulation of the prostate has been criticized because the extent of tissue destruction cannot be controlled and many patients may be expected to have significant postoperative obstructive as well as irritative voiding symptoms which may last for weeks. Thanks to new laservaporization techniques these disadvantages have been largely eliminated. With the Holmium laser a real resection of prostatic tissue is possible allowing the surgeon to see the prostatectomy defect immediately and to assess tissue destruction during the operation (“what you see is what you get”). The postoperative voiding disturbances are diminished and comparable to those after TUR-P. At the Departement of Urology of the University of Berne 116 patients were treated with the Holmium laser for benign prostatic hyperplasia (BPH). During the initial learning period 12 patients required a secondary TUR-P due to persistent obstruction and in 12 patients a combined laser/conventional resection was performed due to underestimated prostate size. 5 patients were lost to follow-up. In the remaining 87 patients the median duration of catheterization was 2 days. 10/87 patients required postoperative treatment for urinary tract infection. There were no significant perioperative decreases in hemoglobin and no cases of TUR syndrome. 66 patients have been followed for 6 months and 30 patients have been followed for 12 months. The maximum urinary flow improved from 7 ml/s preoperatively to 15 ml/s at 6 months and 14 ml/s at 12 months. The volume of residual urine decreased from a median of 120 ml preoperatively to 24 ml at 6 and 12 months. The IPSS decreased from a median of 20 preoperatively to 3 at 6 and 12 months. In 50 patients followed with pressure-flow study pre- and 6 months postoperatively detrusor pressure at maximum flow decreased from 90 cm H₂O to 55 cm H₂O and linear PURR sank from 2,06 to 0,6. Taking into account the initial learning curve, transurethral Holmium laser resection of the prostate is a promising method of treatment for BPH as shown by the increase in urinary flow and decrease in detrusor pressure. Although it does not yet rank equally with TUR-P, it is a less invasive alternative providing efficient, safe and almost bloodless treatment of BPH.      

Holmium:YAG- und erbium :YAG-infrarotlaser-osteotomie

Zusammenfassung Die knochenablative Wirksamkeit der gepulsten Festkörperlaser Holmium:YAG ( = 2120 nm) and Erbium:YAG ( = 2940 nm) wurde im Tierversuch vergleichend untersucht. Als Modell für eine klinische Anwendung wurden partielle Oberkiefer-, Unterkiefer-und Nasenbeinosteotomien an der Ratte durchgeführt. In einer ersten Versuchsreihe wurden die unmittelbare klinische Wirkung und das histologische Wirkungsprofil dieser Infrarotlaser am Hartgewebe erforscht und die Temperaturgradienten im Knochen während der Laseranwendung gemessen. Die geringe Ausdehnung der Schädigungszone im Randbereich der Laserinzisionen und das für den Erbium:YAG-Laser praktisch atraumatische, athermische Knochenabtragungsvermögen läßt die neuen Infrarotlaser als ideale Schneidegeräte für Osteotomien erscheinen.

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Holmium:YAG laser and erbium:YAG laser infrared laser osteotomy

Summary The in-vivo bone ablation characteristics of a pulsed solid-state erbium:YAG laser were compared to those of a pulsed solid-state holmium:YAG laser. Partial osteotomies in the maxillary, the mandibulary, and the nasal bones of white rats were performed. The tissue response was examined by light microscopy. Thermal gradients following the laser application were also measured. Over all energy levels tested the erbium:YAG laser produced ablation of bone with minimal thermal damage to the adjacent tissue. The results of this study are promising for future application of the infrared holmium-and erbium:YAG lasers in otorhinolaryngology.

     

输尿管镜硬镜结合钬激光治疗100例输尿管结石临床分析

目的:探讨并分析输尿管镜硬镜结合钬激光治疗输尿管结石患者的临床疗效和安全程度,并为临床应用提供依据。方法:对100例输尿管患者运用输尿管镜硬镜结合钬激光治疗的过程进行临床性的回顾性分析。结果:93例患者手术成功,7例患者失败,对此7例患者根据病情,分别采取不同的治疗方法后,患者的结石全部排除。结论:输尿管镜硬镜结合钬激光治疗输尿管结石是一种安全有效的微创性的手术方法,能显著提高碎石成功率,改善患者预后,且仪器操作简便,手术时间明显缩短,故临床上应予以广泛使用。     

Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis

PurposeTo report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatography (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL).Patients and methodsA retrospective review of 12 patients who underwent PTBLL for intrahepatic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46 ± 18 (SD) years (range: 23–75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100 nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes.ResultsEleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with long-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3–84 months).ConclusionFor patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment.