Wendt-Nordahl Gunnar, Krombach Patrick, Hannak Dieter, Häcker Axel, Michel Maurice Stephan, Alken Peter, Knoll Thomas
Department of Urology, University Hospital Mannheim, Germany.
BJU Int. 2007 Dec;100(6):1339-43. doi: 10.1111/j.1464-410X.2007.07127.x.
There has been controversy over whether extracorporeal shock wave lithotripsy (ESWL) can cause damage to the endocrine cells of the pancreas, leading to the later development of diabetes mellitus. Authors from Germany prospectively evaluated acute endocrine pancreatic injury as collateral damage caused by the ESWL for treating upper urinary tract stones. In a careful study they showed that there was no effect on serum levels of variables indicating exocrine and endocrine pancreatic tissue damage, suggesting that the idea that ESWL might lead to future diabetes mellitus is unlikely to be correct.
To detect acute damage to pancreatic cells by extracorporeal shock wave lithotripsy (ESWL), with a focus on endocrine function, as recently the development of diabetes mellitus has been suggested to be a late complication of treatment of upper urinary tract stones, and injury to pancreatic tissue by ESWL, leading to insufficient endocrine function, has been proposed as an explanation of this effect.
The study included 12 consecutive patients treated with ESWL for proximal ureteric or kidney stones, using a third-generation electromagnetic lithotripter. To evaluate pancreatic tissue injury caused by ESWL we determined blood variables known to indicate exocrine and endocrine pancreatic cell damage; blood samples were taken before, during, immediately after, and 1 h and 24 h after ESWL to determine the serum levels of amylase, lipase, insulin, glucose, c-peptide and glucagon. Eight patients treated with ESWL for distal ureteric stones were evaluated in the same way and served as the control group.
Neither the variables indicating islet cell damage (c-peptide, insulin and glucagon), nor those indicating damage of exocrine pancreatic cells (amylase and lipase) changed significantly over the time course in both groups.
We could detect no immediate effect on the serum levels of variables indicating exocrine or endocrine pancreatic tissue damage caused by ESWL for urinary tract stones. The hypothesis that ESWL leads to pancreatic trauma with consecutive development of diabetes mellitus therefore seems unlikely.
关于体外冲击波碎石术（ESWL）是否会对胰腺内分泌细胞造成损伤，进而导致后期糖尿病的发生，一直存在争议。德国的作者前瞻性地评估了ESWL治疗上尿路结石时作为附带损伤的急性胰腺内分泌损伤。在一项严谨的研究中，他们表明，ESWL对指示胰腺外分泌和内分泌组织损伤的血清变量水平没有影响，这表明ESWL可能导致未来糖尿病的观点不太可能正确。
检测体外冲击波碎石术（ESWL）对胰腺细胞的急性损伤，重点关注内分泌功能，因为最近有人提出糖尿病的发生是上尿路结石治疗的晚期并发症，而ESWL对胰腺组织的损伤导致内分泌功能不足被认为是这种效应的一种解释。
该研究纳入了12例连续接受ESWL治疗近端输尿管或肾结石的患者，使用第三代电磁碎石机。为了评估ESWL引起的胰腺组织损伤，我们测定了已知指示胰腺外分泌和内分泌细胞损伤的血液变量；在ESWL治疗前、治疗期间、治疗后即刻、治疗后1小时和24小时采集血样，以测定淀粉酶、脂肪酶、胰岛素、葡萄糖、C肽和胰高血糖素的血清水平。对8例接受ESWL治疗远端输尿管结石的患者进行了同样的评估，并作为对照组。
两组中，指示胰岛细胞损伤的变量（C肽、胰岛素和胰高血糖素）以及指示胰腺外分泌细胞损伤的变量（淀粉酶和脂肪酶）在整个时间过程中均未发生显著变化。
我们未发现ESWL治疗尿路结石对指示胰腺外分泌或内分泌组织损伤的血清变量水平有即刻影响。因此，ESWL导致胰腺创伤并继而发展为糖尿病的假说似乎不太可能成立。
