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背景:冲击波对人体组织具有损伤作用,因此冲击波体内碎石仪有一定的能量阈值才具有使用安全性。目的:探讨应用冲击波对体内结石进行爆破的安全性和实用性。设计:观察对比实验。单位:解放军第四军医大学唐都医院实验外科。材料:实验于2001-07/2001-08月在解放军第四军医大学唐都医院实验外科完成。选择健康成年杂种犬6只,体质量9.5～24kg,雌雄不拘。随机分为两组,术后处死组5只,术后饲养组1只。方法:将6只杂种犬全麻后将大小不等的人体结石固醇石、混合石或色素石放入胆囊内部;再选择3段不同的小肠段,用肠钳阻断一端,将结石放入小肠内,用胆道镜引入探头到胆囊及小肠腔内结石上方1mm处,选用不同的冲击能量施放冲击波,直至结石粉碎(其大小<2mm×2mm×2mm),并肉眼观察胆囊及小肠内膜损伤情况。术后处死组犬术后立即处死,分别取其胆囊和实验段小肠进行病理检查。缝合术后饲养组犬的胆囊和小肠,关腹进行饲养,1个月后处死,取其胆囊和实验段小肠,进行病理检查,观察其自行恢复情况。主要观察指标:①冲击波冲击能量与结石种类的关系。②各组犬术后胆囊和小肠组织的病理检查结果。结果:6只犬全部进入结果分析,无脱失。①在同样的冲击能量下,击碎固醇石所需的冲击次数最少,色素石最多。②当冲击能量<4.0J时,犬胆囊和小肠黏膜细胞膜轻度充血,出现小出血点;当冲击能量>4.0J时,黏膜有脱落,出现黏膜下组织水肿。结论:冲击波体内碎石仪对于不同种类的胆结石具有能量依赖性,在冲击能量不大于4.0J时,对组织所造成的损伤轻微,因此冲击能量4.0J可以作为该仪器临床应用的能量阈值。
Background: Shockwave has a damaging effect on human tissue, so the shockwave lithotripsy device has a certain energy threshold before it can be used safely. Objective: To investigate the safety and practicability of using shock wave to blast stones in the body. Design: observe the contrast experiment. Unit: Experimental Surgery, Tangdu Hospital, Fourth Military Medical University. MATERIALS: Experiments were performed in Experimental Surgery, Tangdu Hospital, Fourth Military Medical University from 2001-07 to 2001-08. Select 6 healthy adult hybrid dogs, body weight 9.5 ~ 24kg, male or female. Randomly divided into two groups, 5 postoperative death group, postoperative feeding group 1. METHODS: Six dogs were randomly divided into four groups: human gemstone, mixed stone or pigment stone of different sizes were placed inside the gallbladder after general anesthesia. Three different segments of small intestine were selected, one end was blocked with intestinal forceps, Into the small intestine, the introduction of the choledochoscope with the probe to the gallbladder and small intestine within 1mm above the stones, use different impact energy cast shock wave until the stone crushed (its size <2mm × 2mm × 2mm), and macroscopic observation of the gallbladder and small intestine Injury situation. After operation, the dogs were sacrificed immediately after operation, and the gallbladder and the small intestine of the experimental section were taken for pathological examination. After suture, the dogs were fed with gallbladder and small intestine. The animals were housed for one month and sacrificed one month later. The gallbladder and experimental small intestine were taken for pathological examination to observe their self-recovery. MAIN OUTCOME MEASURES: ① The relationship between shock energy and stone types. ② pathological examination results of gallbladder and small intestine in dogs after operation. Results: All the 6 dogs entered the result analysis without any loss. ① In the same impact energy, crushing sterol stone the impact of the least number of times, most of the pigment stone. ② When the impact energy is less than 4.0J, the dog’s gallbladder and small intestinal mucosa cell membrane mild hyperemia, a small bleeding point; when the impact energy> 4.0J, mucosal shedding, submucosal tissue edema. CONCLUSIONS: The shock wave lithotripsy instrument is energy-dependent for different types of gallstones. When the impact energy is less than 4.0 J, the damage to the tissue is slight, so the impact energy of 4.0 J can be used as the energy threshold for the clinical application of the instrument.