Development of the system for extracorporeal stone disintegration using microexplosion;Disintegration of renal and gall stone.

我们研制了一种以化学炸药（叠氮化银，10 mg）为能量源的体外冲击波碎石机。自1985年3月开始临床应用此方法（mESWL）。至1987年5月共治疗229例，临床成功率96%。用99 mTC-二巯基丁二酸肾摄取率测定肾功能，结果表明，对肾功能无明显不良影响。并发菌血症1例，消化道出血1例，肾包膜下血肿2例。并发症发生率与Dornier系统基本相当。除1例包膜下血肿经皮穿刺引流外，其余均保守治疗。结果表明，mESWL治疗上尿路结石安全、有效。我们相信我们的系统可以充分应用于临床使用，但它也有一些缺点，如爆炸声和使用水槽。由于爆炸时的噪声水平已被证明与Dornier系统（HM-1）几乎相同，因此噪声似乎不是一个大问题。从冲击波传播的效率的观点来看，优选的是在冲击波反射器和人体之间没有内插材料。然而，水槽的采用使整个系统变得复杂。在这方面，我们正在尝试mESWL中的无tgub系统，并研究另一种能源，如压电陶瓷。为了评价我们的系统，不仅从临床治疗的有效性和操作的容易性，而且从经济的角度来看，我们需要更详细的资料，其他碎石机。然而，日本独创的碎石机的研制，刺激了冲击波的研究，使冲击波在我国生物医学领域的广泛应用又向前迈进了一步。

We have developed the extracorporeal shock wave lithotriper using chemical explosives(silver azide, 10mg) as an energy source of shock wave generation. This method(mESWL) was applied clinically since March 1985. Up to may 1987 a total of 229 cases was treated with 96% of clinical success rate. Renal function estimated by 99mTC-dimercaptosuccinic acid renal uptake-rate revealed no sighnificant deleterious effect on the renal function. As the complication, 1 case of bactgeremia, 1 case of gastro-intestinal bleeding and 2 cases of subcapsular renal hematoma were observed. The occurrence rate of complication was almost equivalent to Dornier System. All these complicated cases were Lreated conservatively, except 1 case of percutaneous drainage in the subcapsular hematomas. The results indicated that mESWL is safe and effective for the tratment on the upper urinary tract calculi. We belive tghat our system can sufficiently apply to the clinacal usage, however, it has also several disadvantages, such as an explosion sound and the use of water-tub. As the noise level in the explosion has been proved to be almost same compared to the Dornier System(HM-1), so the noise seems to be not a great probelm. From a point of efficienty of shock wave propagation, it is preferable that no interpolated material betwee a shock wave reflecter and a human body. Nonetheless, the adoption of a water-tub make the whole system complex. in this regard, we are trying a tgub-less sytem in mESWL, and study on another energy source, such as piezoceramics. in order to evaluate our system, not only from the efficicency in the clinical treatment and the easiness in the manipulation, but also form the economical point of view, we need more detailed information about other lithotripters. However, the development of a original made-in-japan lithotripter stimulates the researach on shock waves, and makes another step to apply the method widely to biomedical fields in this country.