Recker F, Rübben H, Bex A, Constantinides C
Department of Urology, RWTH, Aachen, Federal Republic of Germany.
Urol Res. 1989;17(4):229-33. doi: 10.1007/BF00262598.
Fifty four Wistar rats were treated with 500, 1,000 or 2,000 shock waves, using the modified DORNIER HM 3 system with the new SG40 shock wave generator. The animals were sacrificed after a period of 24 hours, 7 days or 35 days. Histological examination, scanning electron microscopy (SEM) and magnetic resonance imaging (MRI) were used to evaluate acute and long term effects after extracorporeal shock-wave lithotripsy (ESWL). Acute morphological changes such as glomerular bleeding, tubular dilatation, atrophy and partial necrosis occurred immediately after ESWL throughout the kidney. SEM revealed a tubular loss of microvilli and cilia. There was restitutio ad integrum of these diffuse lesions. The extent of the long term lesions was determined by the following mechanism: venous rupture occurred during ESWL, especially in thin arcuatae veins which are, tortuous their and run between two different tissue densities. This resulted in interstitial haematoma, demonstrable by MRI; in the long term groups, the haematomas progressed to interstitial fibrosis with segmental retraction of renal convexity. The blood supply in these areas was reduced and secondary changes such as glomerular-tubular atrophy and sclerosis followed. The degree to which long-term renal lesions resulted was determined by the extent of these changes, which were shock-wave dose dependent up to a dose of 2,000 shock waves.
使用配备新型SG40冲击波发生器的改良多尼尔HM 3系统，对54只Wistar大鼠施加500、1000或2000次冲击波。在24小时、7天或35天后处死这些动物。采用组织学检查、扫描电子显微镜（SEM）和磁共振成像（MRI）来评估体外冲击波碎石术（ESWL）后的急性和长期影响。ESWL后，整个肾脏立即出现急性形态学变化，如肾小球出血、肾小管扩张、萎缩和部分坏死。SEM显示肾小管微绒毛和纤毛缺失。这些弥漫性病变可完全恢复。长期病变的程度由以下机制决定：ESWL过程中发生静脉破裂，尤其是在走行于两种不同组织密度之间且迂曲的细弓状静脉中。这导致间质血肿，MRI可显示；在长期组中，血肿进展为间质纤维化，并伴有肾凸面节段性回缩。这些区域的血液供应减少，随后出现肾小球-肾小管萎缩和硬化等继发性变化。长期肾脏病变的程度取决于这些变化的程度，并在冲击波剂量达到2000次之前呈剂量依赖性。
