重新思考高频碎石术：欧洲泌尿外科学会腔内泌尿学组的综述。
完整摘要 · 中文译文
目的：评估比较高频率（HF）（>20 Hz）与低频率（LF）（≤20 Hz）激光碎石术在因肾及输尿管结石接受软性和/或硬性输尿管镜检查患者中的当前证据，重点关注结石清除率（SFR）、手术结局和安全性。 方法：按照系统综述和荟萃分析优先报告条目（PRISMA）指南进行系统综述。检索MEDLINE和EMBASE数据库，时间截至2025年10月，纳入接受输尿管镜下激光碎石术并使用钬：钇铝石榴石（Ho: YAG）、掺铥光纤激光器（TFL）和脉冲铥：YAG（p-Tm: YAG）激光器的患者相关的随机对照试验（RCT）、前瞻性比较研究和单臂研究。主要结局包括SFR，次要结局包括手术持续时间、能量利用和并发症。 结果：共纳入22项研究，包含2059例患者。结石清除率（SFR）在低频（LF）组（67-100%）和高频（HF）组（77-100%）之间显示出显著重叠。手术时间在LF组为24.7至96.6分钟，HF组为19.9至90分钟。能量消耗（J/mm³）显示出相似范围：LF组为8.7-29.03 J/mm³，HF组为1.6-27.9 J/mm³。总体并发症发生率保持在较低水平（4-21%）。值得注意的是，使用铥光纤激光器（TFL）并将高频（HF）与高功率（HP）设置相结合治疗肾结石的研究报告了较高的输尿管损伤率（3.1-4.4%）。感染性并发症表现出频率依赖性模式，高频、高功率钬激光（HF，HP Ho:YAG）设置在大结石患者中的泌尿道感染（UTI）/脓毒症发生率高达2.9%。出血并发症与激光技术的关系似乎比与频率设置的关系更强，术中出血更多见于使用钬激光（Ho:YAG）时，术后血尿更多见于使用铥光纤激光器（TFL）时。 结论：HF和LF设置实现了可比的SFR和手术时间。在两个频率范围内，输尿管损伤的总体发生率均较低。然而，在将HF设置与HP联合使用的研究中，观察到较高的输尿管损伤和感染发生率。出血并发症被发现与激光技术相关，而与频率无关。
完整摘要 · 英文原文
PURPOSE: To evaluate the current evidence comparing high-frequency (HF) (> 20 Hz) versus low-frequency (LF) (≤ 20 Hz) laser lithotripsy in patients undergoing flexible and/or rigid ureteroscopy for renal and ureteral stones, with focus on stone-free rate (SFR), operative outcomes, and safety profiles. METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted on MEDLINE and EMBASE databases through October 2025 for randomized controlled trials (RCT), prospective comparative studies, and single-arm studies involving patients undergoing ureteroscopic laser lithotripsy with holmium: yttrium aluminum-garnet (Ho: YAG), thulium fiber lasers (TFL), and pulsed Thulium: YAG (p-Tm: YAG) lasers. Primary outcomes included SFR, and secondary outcomes included operative duration, energy utilization, and complications. RESULTS: Twenty-two studies encompassing 2,059 patients were included. SFR demonstrated substantial overlap between LF (67-100%) and HF (77-100%) groups. Operative times ranged from 24.7 to 96.6 min for LF and 19.9-90 min for HF settings. Energy consumption (J/mm³) showed similar ranges: 8.7-29.03 J/mm³ for LF and 1.6-27.9 J/mm³ for HF groups. Overall complication rates remained low (4-21%). Notably, studies using TFL combining HF with high-power (HP) settings for renal stones reported elevated ureteral injury rates (3.1-4.4%). Infectious complications demonstrated frequency-dependent patterns, with HF, HP Ho: YAG settings showing UTI/sepsis rates up to 2.9% in patients with large stones. Bleeding complications appeared more strongly associated with laser technology than frequency settings, with intra-op bleeding occurring more with use of Ho: YAG laser and post-op hematuria occurring more with TFL use. CONCLUSION: HF and LF settings achieved comparable SFR and operative times. The overall incidence of ureteral injury across both frequency ranges was low. However, higher instances of ureteral injury and infection were observed in studies where HF settings were used in combination with HP. Bleeding complications were found to be related to laser technology rather than frequency.