Frankenschmidt A, Heisler M
Department of Urology, University Hospital Freiburg, Germany.
J Endourol. 1998 Feb;12(1):15-21. doi: 10.1089/end.1998.12.15.
The potential effects of extracorporeal application of shockwaves on an embryo or fetus were explored in an animal model. In experimental Series A, the fetuses of 30 gravid rabbits were exposed to piezoelectrically induced and sonographically guided shockwaves on Day 25 or 20 of gestation under technical conditions corresponding to extracorporeal lithotripsy in humans. Fetotoxicity was examined by abdominal section 24 hours or 9 days later, and immediate/intermediate damage was assessed (resorptions, viability, gross injuries, and microscopic lesions of the target and neighboring fetuses). In series B, the kidneys of an additional 28 gravid rabbits (including a control group) were exposed to the same shockwave treatment on Day 11 of gestation in order to investigate indirect embryotoxic effects, including teratogenic potency. One day before the expected birth, the maternal kidneys, uteri, and adjacent organs were examined for lesions, and the 156 offspring were assessed for embryolethal, embryonoxious, or teratogenic sequelae. Shockwave targeting of the cranium, thorax, abdomen, or placenta was usually lethal to the fetuses. When the uterine wall or the space between two fetuses was targeted, the fetuses suffered from superficial hematoma, as was found in the surrounding soft tissues within a radius of 1.5 cm. Fetuses outside this region were vital and free of lesions. Shockwave treatment of the maternal kidney resulted in renal petechial hemorrhage or subcapsular hematoma. However, statistically significant embryotoxic or teratogenetic effects could be demonstrated neither from maternal data (resorptions) nor from fetal findings (body measurements, vitality test, inner organs, skeletal deformities). When using a piezoelectric lithotripter with a small focus of high energy, lesions of a fetus are to be expected only when it is located in or close to the focus. It seems that embryotoxic or teratogenic sequelae do not occur when shockwaves are focused outside the uterus. Nonetheless, this preliminary research does not justify clinical use of extracorporeal shockwave lithotripsy in pregnant humans.
在动物模型中探究了体外冲击波对胚胎或胎儿的潜在影响。在实验A组中，在妊娠第25天或第20天，在相当于人类体外冲击波碎石术的技术条件下，对30只妊娠兔的胎儿进行压电诱导并在超声引导下施加冲击波。24小时或9天后通过剖腹检查胎儿毒性，并评估即刻/中期损伤（吸收、活力、大体损伤以及靶胎儿和相邻胎儿的微观病变）。在B组中，另外28只妊娠兔（包括一个对照组）的肾脏在妊娠第11天接受相同的冲击波治疗，以研究间接胚胎毒性作用，包括致畸潜能。在预期分娩前一天，检查母兔的肾脏、子宫和相邻器官有无病变，并评估156只后代有无胚胎致死、胚胎毒性或致畸后遗症。冲击波靶向颅骨、胸部、腹部或胎盘通常会导致胎儿死亡。当靶向子宫壁或两个胎儿之间的间隙时，胎儿会出现浅表血肿，在半径1.5厘米范围内的周围软组织中也发现了这种情况。该区域外的胎儿存活且无病变。对母兔肾脏进行冲击波治疗会导致肾点状出血或肾包膜下血肿。然而，无论是从母体数据（吸收情况）还是从胎儿检查结果（身体测量、活力测试、内脏、骨骼畸形）中，均未发现具有统计学意义的胚胎毒性或致畸作用。当使用能量聚焦小的压电碎石机时，只有当胎儿位于焦点处或靠近焦点时才可能出现损伤。似乎当冲击波聚焦在子宫外时不会出现胚胎毒性或致畸后遗症。尽管如此，这项初步研究并不足以证明体外冲击波碎石术可用于临床妊娠患者。
