Dretler S P
Department of Urology, Massachusetts General Hospital, Boston 02114.
J Urol. 1988 May;139(5):1124-7. doi: 10.1016/s0022-5347(17)42801-1.
The ESWL retreatment rates for calculi of 1.1 to 3.0 cm. varied according to stone composition: calcium oxalate monohydrate (COM) 10.3%, calcium oxalate dihydrate (COD) 2.8%, struvite/apatite calculi 6.4%. Fine detail in-vitro radiographs of approximately equal sized calculi composed of COM, COD, struvite, brushite, uric acid and cystine showed structural differences which may account for differences in their fragility. The same six calculi were fragmented in vitro in the Dornier HM3 lithotriptor by 200 shocks at 18 KV and the percent weight of each calculus able to be filtered through a two mm. sieve was determined; COD and uric acid (100%); COM (64%); struvite (57%); brushite (47%); cystine (16%). The linear density of these calculi, measured by single photon emission absorbtiometry, correlated with radio-density, not fragility. Calculi of varying composition respond differently to shock wave fragmentation. The assessment of the capability of ESWL to fragment a stone will determine the size stone selected for treatment. Therefore, "stone fragility" is a new distinction which deserves to be included in the conversation about urinary calculi.
1.1至3.0厘米结石的体外冲击波碎石术（ESWL）再次治疗率因结石成分而异：一水草酸钙（COM）为10.3%，二水草酸钙（COD）为2.8%，磷酸镁铵/磷灰石结石为6.4%。由COM、COD、磷酸镁铵、透钙磷石、尿酸和胱氨酸组成的大小近似结石的体外高分辨率X光片显示出结构差异，这可能解释了它们易碎性的不同。同样的六种结石在体外通过多尼尔HM3碎石机以18千伏进行200次冲击进行破碎，并测定每种结石能够通过2毫米筛网的重量百分比；COD和尿酸（100%）；COM（64%）；磷酸镁铵（57%）；透钙磷石（47%）；胱氨酸（16%）。通过单光子发射吸收测定法测量的这些结石的线密度与放射密度相关，而非易碎性。不同成分的结石对冲击波破碎的反应不同。评估ESWL破碎结石的能力将决定所选治疗结石的大小。因此，“结石易碎性”是一个新的区别，值得纳入关于尿路结石的讨论中。
