Karalezli G, Gögüş O, Bedük Y, Köküuslu C, Sarica K, Kutsal O
Department of Urology, Ibn-i Sina Hospital, University of Ankara Medical School, Turkey.
Urol Res. 1993 Jan;21(1):67-70. doi: 10.1007/BF00295196.
Despite the widespread clinical use of the lithotriptor, the margin of safety for the kidney during shock wave application is substantially unknown. Although a series of pilot studies have been performed in laboratory animals, long-term follow-up is mandatory to establish the effect of extracorporeal shock wave lithotripsy (ESWL) and subsequent dose-dependent changes on the kidneys. An experimental study was performed in 45 rabbits; to define and compare the early and late complications of ESWL in the kidneys. The rabbits were divided into three groups of 15 animals each that received 1000, 1500 or 3000 shock waves respectively at 15-20 kV. The rabbits in each group were killed and necropsy performed within 24 h for the first 5 animals, 1 week for the second 5 animals and 2 months post-ESWL for the last 5 animals. Dose-dependent moderate damage (subcapsular hemorrhage, interstitial hemorrhage, capsular tension and perirenal hemorrhage) were noted in all kidneys at 24 h after treatment. Evidence of permanent changes (some fibrosis, tubular and glomerular damage, chronic inflammatory alterations) was noted in long-term follow up. Complete necrosis of the treated kidney was not encountered in this study.
尽管碎石机在临床上已广泛应用，但在冲击波应用过程中肾脏的安全边际仍基本未知。虽然已在实验动物身上进行了一系列初步研究，但要确定体外冲击波碎石术（ESWL）的效果以及随后肾脏中剂量依赖性变化，长期随访是必不可少的。对45只兔子进行了一项实验研究，以界定和比较ESWL对肾脏的早期和晚期并发症。将兔子分成三组，每组15只，分别在15 - 20 kV下接受1000、1500或3000次冲击波。每组中的兔子分别在治疗后的前5只动物在24小时内处死并进行尸检，第二组5只动物在1周后处死并进行尸检，最后5只动物在ESWL后2个月处死并进行尸检。治疗后24小时，在所有肾脏中均观察到剂量依赖性的中度损伤（包膜下出血、间质出血、包膜张力和肾周出血）。在长期随访中发现了永久性变化的证据（一些纤维化、肾小管和肾小球损伤、慢性炎症改变）。在本研究中未遇到治疗肾脏的完全坏死情况。
