目的 :研究大功率 ( 60 W以上 )钬激光粉碎结石的性能及其有效合理的碎石参数。方法 :1体外实验 :将 12枚泌尿系结石 (结石成分为尿酸结石、草酸结石、磷酸结石 ,大小 1.0～ 2 .0 cm)浸于生理盐水中 ,在不同钬激光参数设置下 ,用钬激光粉碎结石 (结石粉碎至 <0 .5mm) ,观察钬激光碎石能力、合理有效的参数设置及对不同成分结石的碎石情况等。2临床应用 :经耻骨上穿刺 ,用大功率钬激光治疗膀胱结石 6例 ,结石成分为尿酸结石、草酸结石等 ,大小 1.0～ 3.0 cm,其中 1例并发膀胱肿瘤 (肿瘤直径约 1.0 cm)。结果 :钬激光可以粉碎所有 2 3枚结石 ,时间 2～ 2 0 min,其中尿酸结石最容易粉碎 ,且安全有效 ,术中无膀胱穿孔、膀胱出血等并发症 ,术后仅需留置导尿管 1～ 3d(甚至可以不留置导尿管 ) ,患者痛苦小 ,恢复快。对体外冲击波及腔内液电碎石无效的结石也可粉碎 ,且可一并切割、气化膀胱肿瘤。结论 :大功率钬激光可以粉碎不同成分的泌尿系结石 ,碎石效果确实 ,术中无并发症 ,患者无痛苦 ,操作技术简单。 Objective: To study the performance of high power (more than 60 W) holmium laser crushed stone and its effective and reasonable crushed stone parameters. In vitro experiments: Twelve urinary calculi (uric acid stones, oxalic stones, phosphate stones, 1.0 ~ 2.0 cm in size) were immersed in saline. Urinary stones were treated with holmium laser Crushed stones (stones crushed to <0.5mm), observed holmium laser lithotripsy capacity, reasonable and effective parameter settings and different components of stone lithotripsy and so on. 2 clinical application: the suprapubic puncture, with high-power holmium laser treatment of bladder stones in 6 cases, stones composition of uric acid stones, oxalic stones, the size of 1.0 to 3.0 cm, of which 1 case complicated with bladder cancer (tumor diameter of about 1.0 cm). Results: holmium laser can crush all 23 stones, the time of 2 ~ 20 min, of which uric acid stones most likely to smash, and safe and effective, no intraoperative bladder perforation, bladder hemorrhage and other complications, only after indwelling catheter 1 ~ 3d (or even indwelling catheter), the patient pain is small, fast recovery. On the impact of extracorporeal shock and lithotripsy invalid stone can be crushed, and can be cut together, gasification of bladder cancer. Conclusion: The high-power holmium laser can crush urolithiasis with different components. The lithotripsy does have the same effect and no complications during operation. The patient has no pain and the operation technique is simple.