Neubrand M, Greinwald I, Lobentanzer H, Paumgartner G, Hermeking H, Sauerbruch T
II. Medizinische Klinik, Klinikum Grosshadern, Munich, Germany.
Eur J Clin Invest. 1997 Mar;27(3):234-41. doi: 10.1046/j.1365-2362.1997.990648.x.
Efficient fragmentation is the most important prerequisite for successful treatment of gallstones by extracorporeally induced shock waves. No data are available on the amount of energy necessary for stone disintegration and on the threshold energy below which no further fragmentation occurs. We therefore performed an in vitro investigation on human cholesterol gallstones to elucidate physical laws governing shock-wave lithotripsy. First, the focal pressure of the lithotripter was measured to calculate the energy traversing a stone. Second, 96 gallstones from 16 gall bladders were analysed with respect to physicochemical composition, radiological features and ultrasound before fragmentation was performed. Energy for stone disintegration was constant within each stone family but varied between 4.6 mL-1 and 36.8J mL-1 in different families. This energy correlated linearly with stone volume. None of the radiological and physicochemical factors revealed a clear-cut correlation of the different energies necessary for similar stone disintegration. The threshold energy differed between 0.26 mJ and 1.04 mJ per pulse. In conclusion, stone volume was the best parameter predicting stone fragmentation. However, in cholesterol stones with a similar composition the required energy per volume varies considerably together with the threshold energy. Radiological and ultrasound parameters appear to be of minor importance in explaining these differences.
有效的破碎是通过体外冲击波成功治疗胆结石的最重要前提。目前尚无关于结石崩解所需能量以及低于该能量便不会进一步破碎的阈值能量的数据。因此，我们对人体胆固醇结石进行了一项体外研究，以阐明冲击波碎石术的物理规律。首先，测量碎石机的焦点压力以计算穿过结石的能量。其次，在进行破碎之前，对来自16个胆囊的96颗胆结石的物理化学组成、放射学特征和超声情况进行了分析。每个结石组内结石崩解所需的能量是恒定的，但不同组之间在4.6焦耳/毫升至36.8焦耳/毫升之间变化。该能量与结石体积呈线性相关。没有任何放射学和物理化学因素显示出相似结石崩解所需的不同能量之间存在明确的相关性。每个脉冲的阈值能量在0.26毫焦至1.04毫焦之间有所不同。总之，结石体积是预测结石破碎的最佳参数。然而，在组成相似的胆固醇结石中，每单位体积所需的能量以及阈值能量会有很大差异。放射学和超声参数在解释这些差异方面似乎不太重要。
