Kataoka T, Kasahara T, Kobashikawa K, Masuyama T, Watanabe K, Saito T, Ishida H, Yoshida H
Department of Urology, Showa University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1993 May;84(5):851-6. doi: 10.5980/jpnjurol1989.84.851.
Recently several authors have observed tissue damages in ESWL treated kidneys, such as interstitial hemorrhage and edema, cavitation of renal tubular cells and vascular spasms. Examination using renal scintigraphy suggested that these damages could cause a decrease of renal blood flow in the treated kidney. Trying to confirm and further investigate this possibility, we studied on changes of renal blood flow velocity using ultrasound color doppler method in 23 consecutive patients with renal stones who underwent ESWL. The studies were conducted before, immediately after and 1 week after an ESWL treatment. Results were as follows; renal blood flow velocity decreased significantly in the area exposed to shock were immediately after the treatment and returned to the pretreatment levels after 1 week. The changes were not significant in the non-exposed area. In parallel with this decrease of renal blood flow velocity, significant increases of resistive index, pulsatility index and significant decreases of ratio were observed. These parameters calculated by measuring of renal blood flow velocity are known to well correlate with parenchymal vascular resistance. We speculate that these changes in renal parenchymal blood flow velocity are triggered by the tissue damages caused by the exposure to shock wave. The recovery of renal blood flow velocity may depend on the recovery of the tissue damages. Ultrasound color doppler method may make it possible to monitor the recovery of tissue damages induced by shock wave and may provide us with an useful information to determine when to repeat ESWL if needed.
最近，几位作者观察到体外冲击波碎石术（ESWL）治疗后的肾脏出现组织损伤，如间质出血和水肿、肾小管细胞空泡化以及血管痉挛。肾闪烁扫描检查表明，这些损伤可能导致治疗侧肾脏的肾血流量减少。为了证实并进一步研究这种可能性，我们使用超声彩色多普勒方法对23例连续接受ESWL治疗的肾结石患者的肾血流速度变化进行了研究。研究在ESWL治疗前、治疗后即刻以及治疗后1周进行。结果如下：治疗后即刻，受冲击波作用区域的肾血流速度显著下降，1周后恢复至治疗前水平。未受冲击波作用区域的变化不显著。随着肾血流速度的下降，阻力指数、搏动指数显著升高，而比率显著下降。通过测量肾血流速度计算得到的这些参数与实质血管阻力密切相关。我们推测，肾实质血流速度的这些变化是由冲击波暴露导致的组织损伤所引发的。肾血流速度的恢复可能取决于组织损伤的恢复情况。超声彩色多普勒方法或许能够监测冲击波诱导的组织损伤的恢复情况，并为我们在必要时确定何时重复ESWL提供有用信息。
