Akers S R, Cocks F H, Weinerth J L
Department of Mechanical Engineering and Materials Science, Duke University Medical Center, Durham, North Carolina 27706.
J Urol. 1987 Nov;138(5):1295-300. doi: 10.1016/s0022-5347(17)43587-7.
Extracorporeal shock wave lithotripsy (ESWL) can require more than two thousand acoustic shocks to achieve an adequate degree of renal calculus comminution. A decrease in the number of shocks necessary for effective treatment offers both technical and clinical benefits. The results presented here demonstrate that it is possible in particular cases to increase substantially the degree of comminution produced using a fixed number of acoustic impulses by exposing the stones to solutions of controlled pH and chemical composition during acoustic shock treatment. The largest increase in comminution was observed for magnesium ammonium phosphate hexahydrate/apatite stones exposed to citrate solutions. The smaller particle sizes are shown to result not only from stone dissolution but also from an increase in the ease of stone fracture during acoustic shocking. The degree of comminution of the largest fragment sizes was also found to be slightly increased for calcium oxalate stones by exposure to synthetic urine of elevated pH. These chemical methods of increased stone comminution appear to be directly applicable to particular cases and may have general clinical utility if suitable conditions affecting all stones can be found.
体外冲击波碎石术（ESWL）可能需要两千多次声冲击才能达到足够的肾结石粉碎程度。减少有效治疗所需的冲击次数具有技术和临床两方面的益处。此处呈现的结果表明，在特定情况下，通过在声冲击治疗期间将结石暴露于pH值和化学成分可控的溶液中，使用固定数量的声脉冲可大幅提高粉碎程度。对于暴露于柠檬酸盐溶液中的磷酸镁铵六水合物/磷灰石结石，观察到粉碎程度增加最大。较小的颗粒尺寸不仅是由于结石溶解，还因为在声冲击过程中结石更容易破碎。对于草酸钙结石，通过暴露于pH值升高的合成尿液中，最大碎片尺寸的粉碎程度也略有增加。这些增加结石粉碎程度的化学方法似乎直接适用于特定情况，如果能找到影响所有结石的合适条件，可能具有普遍的临床应用价值。
