Department of Urology, Columbia University, New York, New York 10036, USA.
Curr Opin Urol. 2011 Mar;21(2):134-40. doi: 10.1097/MOU.0b013e3283435c1f.
The aim of this review is to evaluate recently published peer reviewed literature on the subject of shockwave lithotripsy.
Based on in-vitro animal studies, escalating voltage results in better stone comminution and ultimately applies less total voltage to the surrounding tissue, theoretically causing less harm. Several studies have also shown that a slower shockwave rate improves stone fragmentation for intrarenal stones. Stones measuring greater than 1000 HU require a significantly greater number of shocks to destroy. The current literature continues to support shockwave lithotripsy as both a safe and effective means for managing stone disease in pediatric patients. Medical expulsive therapy with alpha-blockers appears to be efficacious, shortening the time to stone and fragment expulsion as well as minimizing pain. Skin-to-stone distance, Hounsfield units, stone size, and location are the best studied and most validated parameters that correlate with shockwave lithotripsy success.
Shockwave lithotripsy continues to evolve with the advent of better technology, improved imaging, and the development of several parameters that can be used to predict success, to counsel our patients, and improve stone-free rates.
本文旨在评估冲击波碎石术相关的最新同行评议文献。
基于动物的体外研究，升压可使结石粉碎效果更好，最终对周围组织施加的总电压更低，理论上造成的损害更小。多项研究还表明，较慢的冲击波频率可提高肾结石的碎石效果。对于大于 1000 HU 的结石，需要更多的冲击波才能将其破坏。目前的文献仍然支持冲击波碎石术作为一种安全有效的治疗小儿结石病的方法。α受体阻滞剂的药物排石治疗似乎有效，可缩短结石和碎片排出的时间，并最大程度地减轻疼痛。皮肤-结石距离、Hounsfield 单位、结石大小和位置是研究最多、最有效的与冲击波碎石术成功率相关的参数。
随着更好的技术、改进的成像技术以及可用于预测碎石效果、为患者提供咨询和提高无石率的参数的发展，冲击波碎石术不断发展。
