McAteer J A, Bailey M R, Williams J C, Cleveland R O, Evan A P
Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202-5120, USA.
Minerva Urol Nefrol. 2005 Dec;57(4):271-87.
Research in lithotripsy that started with the effort to characterize acute shock wave damage to the kidney has led to advances on several fronts, including discovery of strategies that have improved clinical treatment. It is appreciated now that shock wave trauma is primarily a vascular lesion, that injury is dose dependent, and that hemorrhage can be severe and can lead to a permanent loss of functional renal mass. Studies of the renal functional response to lithotripsy have shown that shock wave treatment triggers vasoconstriction in the kidney. This finding has been turned to advantage, and it is now known that when treatment is begun using low amplitude pulses, subsequent high amplitude shock waves are far less damaging. Thus, when shock waves are delivered judiciously, treatment can have a protective effect. The finding that cavitation is a key mechanism in vessel rupture has led to the development of novel experimental methods of shock wave delivery that can suppress bubble expansion and minimize tissue damage. Progress has also been made in understanding the physical mechanisms involved in stone comminution, and it is seen that the forces generated by cavitation, shear stress and circumferential squeezing act synergistically to fragment stones. Recent work suggests that a broad focal zone may be an advantage, allowing stones to be broken with lower amplitude pulses. Cavitation has been shown to play a critical role in reducing stone fragments to a size that can be voided. Cavitation is also the factor that limits the rate at which treatment can be performed, as stones break significantly better at slow rate than at fast ratean observation from basic research that is now appreciated in clinical practice. The current environment in lithotripsy research is encouraging. There is great interest in developing new technology, and in finding ways to improve how lithotripsy is performed.
始于对肾脏急性冲击波损伤进行特征描述的碎石术研究，已在多个方面取得进展，包括发现了改进临床治疗的策略。现在人们认识到，冲击波创伤主要是一种血管损伤，损伤程度与剂量有关，出血可能很严重，并可能导致功能性肾组织永久性丧失。对碎石术的肾功能反应的研究表明，冲击波治疗会引发肾脏血管收缩。这一发现已被加以利用，现在已知当使用低振幅脉冲开始治疗时，随后的高振幅冲击波造成的损害要小得多。因此，当明智地施加冲击波时，治疗可产生保护作用。空化是血管破裂的关键机制这一发现，已促成了新型冲击波施加实验方法的开发，这种方法可抑制气泡膨胀并将组织损伤降至最低。在理解结石粉碎所涉及的物理机制方面也取得了进展，可以看到，空化、剪切应力和周向挤压所产生的力协同作用使结石破碎。最近的研究表明，较宽的聚焦区可能具有优势，可使结石用较低振幅的脉冲破碎。已证明空化在将结石碎片减小到可排出的尺寸方面起关键作用。空化也是限制治疗执行速度的因素，因为结石在缓慢速度下破碎的效果明显优于快速速度——这是一项基础研究中的观察结果，现在在临床实践中也得到了认可。当前碎石术研究的环境令人鼓舞。人们对开发新技术以及寻找改进碎石术实施方式的方法有着浓厚兴趣。
