新型固体耦合介质在体外冲击波碎石术中减少气穴现象的实验研究。

Newly designed solid coupling medium for reducing trapped air pockets during extracorporeal shock wave lithotripsy_ a phantom study.

机构信息

Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807, Taiwan.

Department of Surgery, St. Joseph Hospital, Kaohsiung City, Taiwan.

出版信息

BMC Urol. 2021 May 14;21(1):79. doi: 10.1186/s12894-021-00847-y.

DOI:10.1186/s12894-021-00847-y

PMID:33990213

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8120698/

Abstract

INTRODUCTION

Air pockets between the lithotripter head and body surface are almost inevitably generated when applying a handful of gel onto the contact portion of the treatment head and that on the patient's skin during coupling procedure. These air pockets can compromise the transmission of acoustic energy of shock wave and may significantly affect efficacy of stone disintegration. Comparing to conventional gel, this study aims to investigate efficacy of stone disintegration by using a proprietary isolation-coupling pad ("icPad") as the coupling medium to reduce trapped air pockets during ESWL procedure.

METHOD

In this phantom study, Dornier lithotripter (Delta-2 RC, Dornier MedTech Europe GmbH Co., Germany) was used with a proprietary gel pads (icPad, Diameter = 150 mm, Thickness = 4 mm and 8 mm). The lithotripter was equipped with inline camera to observe the trapped air pockets between the contact surface of the lithotripter head. A testing and measuring device were used to observe experimental stone disintegration using icPad and semi-liquid gel. The conventional semi-liquid gel was used as control for result comparison.

RESULTS

The stone disintegration rate of icPad 4 mm and 8 mm after 200 shocks of energy at level 2 were significantly higher than that of the semi-liquid gel (disintegration rate 92.3%, 85.0% vs. 45.5%, respectively, p < 0.001). The number of shocks for complete stone disintegration by icPad of 4 mm and 8 mm at the same energy level 2 were significantly lower than that of the semi-liquid gel (the number of shocks 242.0 ± 13.8, 248.7 ± 6.3 vs. 351.0 ± 54.6, respectively, p = 0.011). Furthermore, quantitative comparison of observed air pockets under Optical Coupling Control (OCC) system showed that the area of air pockets in semi-liquid group was significantly larger than that of the group using icPad (8 mm) and that of the group using icPad (8 mm) after sliding (332.7 ± 91.2 vs. 50.3 ± 31.9, 120.3 ± 21.5, respectively, p < 0.05).

CONCLUSION

The advantages of icPad includes: (1) reduced the numbers of shock wave and increased stone disintegration rate due to icPad's superior efficacy; (2) significantly reduce trapped air pockets in ESWL coupling. Due to the study limitation, more data are needed to confirm our observations before human trials.

摘要

简介

当在碎石治疗头的接触部分和患者皮肤的耦合部分涂上少量凝胶时，几乎不可避免地会在碎石器头部和身体表面之间产生气穴。这些气穴会影响冲击波的声能传输，并可能显著影响结石分解的效果。与传统凝胶相比，本研究旨在通过使用专利隔离耦合垫（“icPad”）作为耦合介质来减少 ESWL 过程中被困的气穴，从而研究结石分解的效果。

方法

在这项体模研究中，使用了 Dornier 碎石机（Delta-2 RC，Dornier MedTech Europe GmbH Co.，德国）和专利凝胶垫（icPad，直径= 150mm，厚度= 4mm 和 8mm）。碎石器配备了内置摄像头，用于观察碎石器头部接触表面之间被困的气穴。使用测试和测量设备观察使用 icPad 和半液态凝胶的实验性结石分解。使用传统的半液态凝胶作为结果比较的对照。

结果

在能量级别为 2 级的 200 次冲击后，icPad 4mm 和 8mm 的结石分解率明显高于半液态凝胶（分解率分别为 92.3%、85.0%对 45.5%，p<0.001）。在相同能量级别 2 级下，icPad 4mm 和 8mm 完成结石完全分解所需的冲击次数明显少于半液态凝胶（冲击次数分别为 242.0±13.8、248.7±6.3 对 351.0±54.6，p=0.011）。此外，光学耦合控制（OCC）系统下观察到的气穴的定量比较表明，半液态组的气穴面积明显大于使用 icPad（8mm）组和使用 icPad（8mm）后滑动组（分别为 332.7±91.2 对 50.3±31.9、120.3±21.5，p<0.05）。