Sheir Khaled Z, Lee David, Humphrey Peter A, Morrissey Kevin, Sundaram Chandru P, Clayman Ralph V
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology. 2003 Nov;62(5):964-7. doi: 10.1016/s0090-4295(03)00685-x.
To study the in vivo tissue effects of synchronous twin pulse technology. Recently, the concept of a synchronous twin pulse technique for shock wave therapy has been introduced with the development of the Twinheads' unit.
In 10 pigs (20 kidneys), one of three sites was targeted: the renal pelvis (2 pigs), the mid-zone parenchyma (5 pigs), or the lower pole parenchyma (3 pigs). The treatment parameters were 1000 twin shock waves at 14 kV with a 90 degrees angle between the shock wave reflectors using a rate of 60 shock waves/min in 17 kidneys and 120 shock waves/min in 3 kidneys. To study the effect of an increasing number of twin shock waves, 4 animals (8 kidneys) were used; the mid-zone parenchyma was subjected to 2000 and 3000 twin shock waves in 4 kidneys each, using a rate of 60 shock waves/min at 14 kV and a 90 degrees angle in all of them. For comparison with the use of a single head, another 3 animals (6 kidneys) were treated with the use of the single under-table head; all of them received 2000 single shock waves at 14 kV focused on the mid zone of the kidney parenchyma. Within 1 hour of treatment, the treated kidneys were harvested, inspected, and sectioned at the focal site, as well as at 1 and 2 cm distant to the focal site.
No gross lesions of the surrounding organs, subcapsular hemorrhage, or parenchymal damage were found at the outer surfaces of the kidneys undergoing twin head shock wave lithotripsy even after 3000 twin shocks. The coronal section revealed minimal gross lesions in 4 of 28 kidneys. Microscopically, the parenchymal changes were minimal. In vivo study of the use of the single under-table head revealed that 5 of 6 kidneys had large subcapsular hematomas at both anterior and posterior surfaces and on coronal section extending into the parenchyma. Microscopically, the changes were significant.
Synchronous twin pulse shock waves induced minimal damage compared with single pulse standard shock waves. Of note, even after 3000 twin pulses (ie, a total of 6000 shock waves), the renal damage remained minimal.
研究同步双脉冲技术的体内组织效应。近年来，随着双头设备的发展，冲击波治疗中的同步双脉冲技术概念被提出。
选取10头猪（20个肾脏），靶向三个部位之一：肾盂（2头猪）、肾实质中区（5头猪）或肾下极实质（3头猪）。治疗参数为14 kV下1000个双冲击波，冲击波反射器之间夹角为90度，17个肾脏的冲击频率为60次/分钟，3个肾脏为120次/分钟。为研究双冲击波数量增加的影响，使用4只动物（8个肾脏）；4个肾脏的肾实质中区分别接受2000和3000个双冲击波，均在14 kV下以60次/分钟的频率、90度夹角进行。为与单头使用情况作比较，另外3只动物（6个肾脏）使用台下单头进行治疗；所有动物均接受14 kV下聚焦于肾实质中区的2000个单冲击波。治疗后1小时内，切除治疗后的肾脏，在焦点部位以及距焦点1厘米和2厘米处进行检查和切片。
即使经过3000次双冲击波治疗，接受双头冲击波碎石术的肾脏外表面也未发现周围器官的明显损伤、包膜下出血或实质损伤。冠状切片显示28个肾脏中有4个有轻微肉眼可见损伤。显微镜下，实质变化轻微。使用台下单头的体内研究显示，6个肾脏中有5个在前后表面均有大的包膜下血肿，冠状切片显示血肿延伸至实质。显微镜下，变化显著。
与单脉冲标准冲击波相比，同步双脉冲冲击波造成的损伤最小。值得注意的是，即使经过3000次双脉冲（即总共6000次冲击波），肾脏损伤仍然最小。
