體外震波碎石術中使用固態耦合介面增加震波效與保護耦合面皮膚之實驗性與臨床研究
陳偉權 陳建旭 張志宏 劉文欽1 楊儀華1
天主教聖功醫療財團法人聖功醫院1 泌尿外科
An Experimental and Clinical Investigation of Solid Coupling Interface for Increasing Shock-Wave Effectiveness and Protecting Coupling Skin During Extracorporeal Shock Wave Lithotripsy
Wei-Chuan Chen, Jian Shiu Chen, Chih-Hung Chang, Wen-Chin Liou1,
Yi-Hua Yang1
Division of Urology, St. Joseph Hospital1
Purpose:
Trapped air pockets in the interface coupling can significantly affect the transmission of shock-wave(SW) during extracorporeal shock wave lithotripsy(ESWL) and a solid coupling medium can markedly eliminate the trapped air pockets. The purpose of this study is to use a solid proprietary isolating coupling pad(“icPad”) as the ESWL coupling medium for increasing SW effectiveness and protecting coupling skin.
Materials and Methods:
The model of stone disintegration using Dornier lithotripter test model which semiliquid sonogel and 4mm and 8mm icPad were used as SW interface. Stone disintegration tests were divided into four groups according the gel characteristic, thickness of interface and energy level of SW. Group 1: 4mm icPad, level 2, Group 2: 8mm icPad, level 2, Group 3: 4mm icPad, level 1, and Group 4: sonogel, level 2. SW will stop when model stone was seen stone free in the basket and number of SW was recorded. SW in this test model was set at energy level 2, rate of 60/min. Skin injury was observed and graded into 5 degrees which included grade 1: normal, grade 2: redness, grade 3: bruising, grade 4: skin rupture, grade:5,oozing.
Results：
Noticeable amount of air pockets were observed in the sonogel group but trapped air pocket was nearly not visible in group using icPad. Number of SW resulting in stone free was similar in group 1 (energy 2, 4mm icPad) and group 2(energy 2, 8mm icPad).
Number of SW resulting in stone free was similar in group 3 (energy 1, 4mm icPad)and group 4(energy 2, sonogel). Number of SW of group 1 and 2 resulting in stone free was significantly less than those in group 3 and 4. Skin injury to the degree of oozing(grade 5) was noted more frequently in group using 4mm icPad and equally in group using sonogel and 8mm icPad.
Conclusions:
Number of SW to achieve stone free using semi-liquid sonogel as coupling interface is significantly more than group using solid icPad. Furthermore, similar results can be achieved by selecting less energy level if using solid icPad. Clinical observation of skin injury was seen in all three groups but only solid icPad has isolative effect to protect skin from cross contamination by oozing during ESWL. Our results suggest that less SW number or decreased energy level may be selected clinically to disintegrate stone when solid coupling interface is used. Solid icPad can also prevent potential skin contamination to achieve patient safety during ESWL.