Mucksavage Phillip, Mayer Wesley A, Mandel Jeff E, Van Arsdalen Keith N
Division of Urology, University of Pennsylvania Health System, Philadelphia, PA;
Can Urol Assoc J. 2010 Oct;4(5):333-5. doi: 10.5489/cuaj.09160.
High-frequency jet ventilation (HFJV) during shock wave lithotripsy (SWL) has been reported using older lithotripsy units with larger focal zones. We investigated how HFJV affects the clinical parameters of SWL using a newer lithotripsy unit with a smaller focal zone.
We reviewed all patients who underwent SWL by a single surgeon (KVA) from July 2006 until December 2007 with the Siemens Lithostar Modularis (Siemens AG, Erlangen, Germany). Either HFJV or conventional anesthetic techniques were used based on the anesthesiologists' preference. Preoperative imaging was reviewed for stone size, number and location. Total operating room time, procedure time, number of shocks and total energy delivery were analyzed. Postoperative imaging was reviewed for stone-free rates.
A total of 112 patients underwent SWL with 80 undergoing conventional anesthesia, and 32 with HFJV. Age, body mass index, preoperative stone size and number were not significantly different between the groups. The HFJV group required significantly less total shocks (3358 vs. 3754, p = 0.0015) and total energy (115.8 joules vs. 137.2 joules, p = 0.0015). Total operating room time, SWL procedure time and postoperative stone-free rates were not significantly different.
Previous studies using older SWL units with larger focal zones have demonstrated that HFJV can be effective in reducing total shocks and total energy. Our data is consistent with these studies, but also shows benefit with newer units that have narrower focal zones.
冲击波碎石术（SWL）期间使用高频喷射通气（HFJV）的报道采用的是具有较大焦点区域的老式碎石设备。我们使用焦点区域较小的新型碎石设备研究了HFJV如何影响SWL的临床参数。
我们回顾了2006年7月至2007年12月期间由同一位外科医生（KVA）使用西门子Lithostar Modularis（德国西门子股份公司，埃尔朗根）为所有接受SWL治疗的患者。根据麻醉医生的偏好，要么采用HFJV，要么采用传统麻醉技术。术前影像检查评估结石大小、数量和位置。分析了总手术室时间、手术时间、冲击次数和总能量传递。术后影像检查评估结石清除率。
共有112例患者接受了SWL治疗，其中80例采用传统麻醉，32例采用HFJV。两组患者的年龄、体重指数、术前结石大小和数量无显著差异。HFJV组所需的总冲击次数（3358次对3754次，p = 0.0015）和总能量（115.8焦耳对137.2焦耳，p = 0.0015）明显更少。总手术室时间、SWL手术时间和术后结石清除率无显著差异。
先前使用具有较大焦点区域的老式SWL设备的研究表明，HFJV可有效减少总冲击次数和总能量。我们的数据与这些研究一致，但也显示出对于焦点区域更窄的新型设备也有好处。
