Höbarth K, Maier A, Hofbauer J, Marberger M
Department of Urology, University of Vienna, Austria.
J Urol. 1993 Dec;150(6):1768-70. doi: 10.1016/s0022-5347(17)35890-1.
This report documents the usefulness of color Doppler sonography for early verification of urinary stone fragmentation during extracorporeal shock wave lithotripsy with ultrasonographic focusing. In the experimental study lithotripsy was performed on human urinary stones placed in pig kidneys. Increasing color flow within the stone mass created by movement of small fragments indicated fragmentation earlier than pixel movement on the standard gray scale sonogram. The success of treatment was demonstrated macroscopically. In the clinical study 25 patients with radiopaque kidney stones were treated by color Doppler guided shock wave lithotripsy and compared to a control group of 32 patients with similar stone characteristics in whom the end point of treatment was chosen based on B-mode sonography alone. The amount of color flow within the stone reflex determined the end point of treatment. The degree of fragmentation was confirmed by fluoroscopy immediately after treatment. Disintegration was successful in all cases and fragments passed spontaneously. Color Doppler imaging during shock wave lithotripsy provides reliable information on the spatial and temporal characteristics of stone fragmentation, and is superior to B-mode sonography by providing more immediate, objective information on stone fragmentation and allowing better evaluation of the focal zone. With the help of this technique, the number of applied shock waves could be reduced by 20% compared with the control group.
本报告记录了彩色多普勒超声在超声聚焦体外冲击波碎石术中对尿路结石破碎早期验证的实用性。在实验研究中，对置于猪肾中的人体尿路结石进行碎石术。由小碎片移动产生的结石团块内颜色血流增加比标准灰阶超声图上的像素移动更早表明结石破碎。肉眼证实了治疗的成功。在临床研究中，对25例不透射线肾结石患者采用彩色多普勒引导冲击波碎石术进行治疗，并与32例具有相似结石特征的对照组患者进行比较，对照组仅根据B型超声确定治疗终点。结石反射内的颜色血流数量决定治疗终点。治疗后立即通过荧光透视确认破碎程度。所有病例均成功碎石，碎片自行排出。冲击波碎石术中的彩色多普勒成像可提供关于结石破碎的空间和时间特征的可靠信息，并且通过提供关于结石破碎的更即时、客观的信息以及允许更好地评估聚焦区，优于B型超声。借助该技术，与对照组相比，施加的冲击波数量可减少20%。
