Stone fragmentation during shock wave lithotripsy is improved by slowing the shock wave rate: Studies with a new animal model
Stone fragmentation during shock wave lithotripsy is improved by slowing the shock wave rate: Studies with a new animal model
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DOI：
10.1016/s0022-5347(05)64357-1
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发表时间：
2002-11-01
影响因子：
6.6
通讯作者：
McAteer, JA
中科院分区：
文献类型：
--
作者：
Paterson, RF;Lifshitz, DA;McAteer, JA
目的：目前无门控冲击波碎石的趋势意味着更多的患者正在接受快速冲击波（每分钟120冲击波或更高）的治疗。然而，增加冲击波率并没有显示出任何好处，体外研究表明，减缓冲击波率实际上可以改善结石碎裂。我们在一个新的动物模型上测试了冲击波速率对石头粉碎的影响。材料和方法：将石膏模型石经上极经皮置入体重约100磅的母猪肾下极杯内。2小时后使用未改装的HM3碎石机（Dornier Medical Systems, Marietta, Georgia）进行冲击波碎石术（以20 kv不间断的400冲击波和每分钟30或120冲击波）。尿道整体切除后，收集结石碎片，用2mm筛网筛过。对颗粒进行称重并测定其表面积。结果：每分钟30冲击波处理的结石比每分钟120冲击波处理的结石破裂更彻底。以每分钟30次冲击波的慢速速度（平均+/- SEM 81% +/- 14% vs 45% +/- 12%）处理的结石中，大于2mm的碎片百分比显著高于以每分钟120次冲击波的快速处理的结石
Purpose: The current trend toward ungated shock wave lithotripsy means that more patients are being treated with shock waves delivered at a rapid rate (120 shock waves per minute or greater). However, no benefit of an increased shock wave rate has been shown and in vitro studies indicate that slowing the shock wave rate actually improves stone fragmentation. We tested the effect of the shock wave rate on stone comminution in a new animal model.Materials and Methods: Gypsum model stones were inserted via upper pole percutaneous access into the lower pole calix of the kidneys of female pigs weighing approximately 100 pounds. Shock wave lithotripsy was performed (400 shock waves uninterrupted at 20 kV. and 30 or 120 shock waves per minute) 2 hours later using an unmodified HM3 lithotriptor (Dornier Medical Systems, Marietta, Georgia). After en bloc excision of the urinary tract stone fragments were collected and sieved through 2 mm. mesh. The particles were weighed and surface area was determined.Results: Stones treated at 30 shock waves per minute broke more completely than stones treated at 120 shock waves per minute. The percent of fragments greater than 2 mm. was significantly higher for stones treated at the fast rate of 120 versus the slow rate of 30 shock waves per minute (mean +/- SEM 81% +/- 14% versus 45% +/- 12%, p