Gillitzer Rolf, Neisius Andreas, Wöllner Jens, Hampel Christian, Brenner Walburgis, Bonilla Arturo Alvarado, Thüroff Joachim
Department of Urology, Johannes-Gutenberg University, Mainz, Germany.
BJU Int. 2009 May;103(9):1284-8. doi: 10.1111/j.1464-410X.2008.08273.x. Epub 2009 Jan 21.
To compare disintegration rates for renal stones treated by 60 vs 120 shock waves (SW)/min at the same energy settings, using standardized validated artificial stones in a pig model.
Gypsum artificial stones (13 x 6 mm) were inserted into the renal pelvis on either side of 12 anaesthetized pigs by open surgery. Extracorporeal SW lithotripsy (ESWL) was applied using a new electromagnetic lithotripter (Lithoskop, Siemens AG Healthcare, Munich, Germany) at 60 and 120 SW/min; 3000 SW were applied to each kidney with the same energy settings. Stone fragments were collected after nephrectomy, passed through calibrated test sieves, and weighed. Fragment size categories were stratified according to the sieve hole size as set by the manufacturer. Fragments of < or =4.75 mm were defined as capable of spontaneous passage. For each pig the number of stone fragments of the respective size categories was counted and weighed. The results were analysed statistically using the Mann-Whitney U-test.
For fragments of >4.75 mm, the median (range) fragment counts were 0 (0-1) for 60 and 1 (0-3) for 120 SW/min (P = 0.006). For small fragments of 2.0-2.8 mm, the median fragment counts were 15 (4-24) for 60 and 10 (2-25) for 120 SW/min (P = 0.033); for fragments of 1.0-2.0 mm the respective values were 42.5 (9-81) and 21.5 (6-56) (P = 0.004). Of the total stone fragment mass in the 60 and 120 SW/min groups, 4.34% and 31.31% were >4.75 mm. There was complete disintegration yielding fragments capable of spontaneous passage in 10 of 12 renal units at 60 and in three of 12 renal units at 120 SW/min. The mean treatment time was 55.4 min for therapy at 60 and 34.3 min for therapy at 120 SW/min (P = 0.001). One parenchymal haematoma of 15 x 10 mm developed in the 60 SW/min group and another of 20 x 10 mm developed in the 120 SW/min group.
ESWL fragmentation with equal energy application yields significantly smaller fragments at 60 than at 120 SW/min. The theoretical stone passage rate could therefore be approximately 80% for 60 vs 25% for 120 SW/min ESWL. Renal haematoma formation was comparable in both groups.
在猪模型中，使用标准化验证的人工结石，比较在相同能量设置下，每分钟60次与120次冲击波（SW）治疗肾结石的碎石率。
通过开放手术将石膏人工结石（13×6mm）插入12只麻醉猪双侧肾盂。使用新型电磁碎石机（Lithoskop，西门子医疗集团，慕尼黑，德国）以每分钟60次和120次SW进行体外冲击波碎石术（ESWL）；在相同能量设置下，对每个肾脏施加3000次SW。肾切除术后收集结石碎片，通过校准的试验筛筛分并称重。根据制造商设定的筛孔尺寸对碎片尺寸类别进行分层。≤4.75mm的碎片定义为能够自然排出。对每只猪，计数并称重各个尺寸类别的结石碎片数量。使用Mann-Whitney U检验对结果进行统计学分析。
对于>4.75mm的碎片，每分钟60次SW时碎片计数中位数（范围）为0（0 - 1），每分钟120次SW时为1（0 - 3）（P = 0.006）。对于2.0 - 2.8mm的小碎片，每分钟60次SW时碎片计数中位数为15（4 - 24），每分钟120次SW时为10（2 - 25）（P = 0.033）；对于1.0 - 2.0mm的碎片，相应值分别为42.5（9 - 81）和21.5（6 - 56）（P = 0.004）。在每分钟60次和120次SW组中，总结石碎片质量中>4.75mm的分别占4.34%和31.31%。在每分钟60次SW时，12个肾单位中有10个完全碎裂产生能够自然排出的碎片；在每分钟120次SW时，12个肾单位中有3个。每分钟60次SW治疗平均时间为55.4分钟，每分钟120次SW治疗平均时间为34.3分钟（P = 0.001）。每分钟60次SW组出现1例15×10mm的实质血肿，每分钟120次SW组出现1例20×10mm的实质血肿。
在相同能量应用下，ESWL碎石时，每分钟60次SW产生的碎片明显小于每分钟120次SW。因此，理论上结石排出率对于每分钟60次SW的ESWL约为80%，对于每分钟120次SW的ESWL约为25%。两组肾血肿形成情况相当。
