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首页> 外文期刊>BJU international >Renal injury during shock wave lithotripsy is significantly reduced by slowing the rate of shock wave delivery.
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Renal injury during shock wave lithotripsy is significantly reduced by slowing the rate of shock wave delivery.

机译：通过减慢冲击波的输送速度，可以大大减少冲击波碎石术中的肾脏损伤。

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OBJECTIVE To assess the tissue protection afforded by simply reducing the rate of shock wave (SW) delivery, compared with studies in the pig in which SW lithotripsy (SWL)-induced vascular damage was significantly reduced by initiating treatment using low-amplitude SWs. MATERIALS AND METHODS Juvenile pigs (6-7 weeks old) were treated with an unmodified lithotripter (HM3, Dornier Medical Systems, Kennesaw, GA) at either 120 or 30 SW/min. Treatment was to one kidney per pig, with SWs (2000, 24 kV) directed to a lower-pole calyx. After treatment, parenchymal haemorrhage was determined morphometrically and expressed as percentage of functional renal volume (%FRV). RESULTS Kidneys treated at 120 SW/min had focal to extensive subcapsular haematomas. Parenchymal lesions were found only at the lower pole, but included regions within renal papillae and the cortex. Occasionally, damage extended across the full thickness of the kidney. The lesion in the pigs treated at 120 SW/min occupied a mean (sd) of 4.6 (1.7) %FRV. Kidneys of pigs treated at 30 SW/min showed no surface bleeding. Parenchymal haemorrhage was limited to papillae within the focal volume, and measured 0.08 (0.02) %FRV, a significant (P < 0.005) reduction in injury. CONCLUSIONS Slowing the rate of delivery to 30 SW/min has a dramatic protective effect on the integrity of the kidney vasculature. This finding in our established pig model suggests a potential strategy to improve the safety of lithotripsy. As it was shown that a reduced SW rate also improves the efficiency of stone fragmentation, a slow rate appears to be a means to improve both the safety and efficacy of SWL.
机译：目的为了评估仅通过降低冲击波（SW）传递速率所提供的组织保护，与在猪中进行的研究相比，在猪中，通过使用低幅SW进行治疗可以显着降低SW碎石术（SWL）引起的血管损伤。材料与方法用未经修饰的碎石机（HM3，Dornier Medical Systems，肯尼索，佐治亚州）以120或30 SW / min的速度处理幼猪（6-7周龄）。治疗方法为每头猪一个肾脏，SW（2000，24 kV）引至下极花萼。治疗后，用形态计量学测定实质出血，并表示为功能性肾体积百分比（％FRV）。结果肾脏以120 SW / min的速度治疗可引起广泛的囊下血肿。实质性病变仅在下极发现，但包括肾乳头和皮质内的区域。有时，损害会遍及整个肾脏。以120 SW / min的速度处理的猪的病变平均（sd）为4.6（1.7）％FRV。以30 SW / min的速度处理的猪的肾脏没有表面出血。实质性出血仅限于焦点体积内的乳头，并测得0.08（0.02）％FRV，损伤的明显减少（P <0.005）。结论将分娩速率减慢至30 SW / min对肾脏血管系统的完整性具有显着的保护作用。在我们已建立的猪模型中的这一发现提出了改善碎石安全性的潜在策略。结果表明，降低的SW速率还可以提高碎石的效率，而缓慢的SW速率似乎可以提高SWL的安全性和有效性。

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