Objective: To compare the efficacy of thulium fiber laser (TFL) and holmium laser (HL) in the treatment of upper urinary tract stones. Methods: A total of 76 patients diagnosed with upper urinary tract stones by radiographic examination and who required ureteroscopy lithotripsy or retrograde intrarenal stone surgery were prospectively enrolled from the Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between January 2022 and June 2022. Patients were divided into TFL group (n=38) and HL group (n=38) in a 1∶1 ratio according to the randomization schedule. The perioperative outcomes and stone-free rate of two groups were recorded and compared. Results: Finally, the clinical data of 71 patients were completely collected, including 55 males and 16 females, with a mean age of (45.7±14.1) years old. There were 36 patients in TFL group and 35 patients in HL group, and there was no significant difference in age, body mass index, gender, Charlson comorbidity index, stone site, stone location, stone size and stone density between two groups (all P>0.05). All the surgeries were successfully performed with no intraoperative complications. There were no significant differences between the two groups in terms of operation time, stone displacement during lithotripsy, visual field clarity, changes in hemoglobin, leukocyte, and C-reactive protein, and length of postoperative hospital stay (all P>0.05), but the laser action time[M (Q1,Q3)] in the TFL group was 30.0 (20.0, 48.8)s, which was significantly shorter than that in the HL group [90.0 (50.0, 120.0)s, P<0.001]. The stone-free rates of TFL group and HL group were 97.2% (35/36) and 88.6% (31/35), and there was no significant difference (P=0.337). The postoperative complication incidences of TFL group and HL group were 36.1% (13/36)and 22.9% (8/35), respectively, and the difference was not significant either (P=0.221). For ureter stones, the laser action time in TFL group was 22.5 (20.0, 43.8)s, which was significantly shorter than that in HL group [80.0 (50.0, 120.0)s, P<0.001]. For stones with maximum diameter≤10 mm, the laser action time in TFL group was 20.0 (10.0, 25.0)s, which was significantly shorter than that in HL group [50.0 (40.0, 80.0)s, P<0.001]. For stones with maximum diameter>10 mm, the laser action time in TFL group was 60.0(42.5, 180.0)s, which was significantly shorter than that in HL group [180.0(120.0, 210.0)s, P=0.035]. For stones with density≤1 000 CT, the laser action time in TFL group was 30.0 (20.0, 45.0)s, which was significantly shorter than that in HL group [95.0 (47.5, 120.0), P=0.001]. For stones with density>1 000 CT, the laser action time in TFL group was 30.0 (20.0, 90.0)s, which was significantly shorter than that in HL group [80.0 (55.0, 180.0)s, P=0.033]. Conclusion: TFL lithotripsy is an effective and safe surgical procedure for the treatment of upper urinary tract stones, with similar clinical efficacy but shorter laser action time compared to HL lithotripsy.
目的： 比较铥光纤激光（TFL）和钬激光（HL）碎石治疗上尿路结石的效果。 方法： 前瞻性纳入2022年1月至6月就诊于浙江大学医学院附属邵逸夫医院泌尿外科，经影像学检查确诊为上尿路结石且需行经尿道输尿管硬镜或软镜激光碎石治疗的患者76例，按照随机分组表法以1∶1的比例将患者分为TFL组（38例）和HL组（38例）。收集患者的临床资料，比较TFL组和HL组患者的围手术期相关指标及清石率。 结果： 最终收集71例患者资料，其中男性55例，女性16例；年龄（45.7±14.1）岁。TFL组36例，HL组35例，两组患者的年龄、体质指数、性别、查尔森合并症指数、结石位置、结石部位、结石大小、结石密度之间的差异均无统计学意义（均P>0.05）。TFL组和HL组患者均顺利完成手术，且未发生术中并发症。TFL组与HL组患者的手术时间、碎石时结石移位、视野清晰度，血红蛋白、白细胞和C反应蛋白的变化差值以及术后住院时间的差异均无统计学意义（均P>0.05）。TFL组患者的激光作用时间［M（Q1，Q3）］为30.0（20.0，48.8）s，短于HL组［90.0（50.0，120.0）s，P<0.001］。TFL组和HL组清石率分别为97.2%（35/36）和88.6%（31/35），差异无统计学意义（P=0.337）。TFL组和HL组术后并发症的总发生率分别为36.1%（13/36）和22.9%（8/35），差异无统计学意义（P=0.221）。对于输尿管结石，TFL组激光作用时间为22.5（20.0，43.8）s，短于HL组［80.0（50.0，120.0）s，P<0.001］。对于长径≤10 mm的结石，TFL组激光作用时间为20.0（10.0，25.0）s，短于HL组［50.0（40.0，80.0）s，P<0.001］；对于长径>10 mm的结石，TFL组激光作用时间为60.0（42.5，180.0）s，短于HL组［180.0（120.0，210.0）s，P=0.035］。对于密度≤1 000 CT的结石，TFL组激光作用时间为30.0（20.0，45.0）s，短于HL组［95.0（47.5，120.0）s，P=0.001］；对于密度>1 000 CT的结石，TFL组激光作用时间为30.0（20.0，90.0）s，短于HL组［80.0（55.0，180.0）s，P=0.033］。 结论： TFL碎石是治疗上尿路结石的一种有效、安全的手术方式，在获得和HL类似临床疗效和安全性的同时，可以缩短激光作用时间。.