以固態藕合墊片之體外震波碎石術中震波條件之選擇對碎石結果之影響
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
Effect of setting of shock wave delivery to stone disintegration in extracorporeal shock wave lithotripsy using solid coupling pad
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 icPad clinically as the ESWL coupling medium at different setting for lithotripsy for the efficacy during ESWL procedure in comparison with the traditional conductive gel.
Materials and Methods:
There were 332 patients who underwent ESWL between Oct. 2017 to
May. 2018. The patients were divided into three groups according to different interface application and ESWL settings as follows: group A1(N=110), IcPad max. 3000/session @PRS 90/min, energy level 2, group A2(N=97), IcPad, max. 2500/session @PRS 80/min, energy level 2 and group C1(N=125), Gel, max. 3000/session @PRS 90/min, energy level 3. The lithotripter used in the study was an electromagnetic Dornier Compact Sigma. The stone disintegration was evaluated by KUB film with or without ultrasonography and follow up to 90 days after ESWL. Stone Free rate (SF) and stone burden less than 4mm(Clinical Insignificant Residual Fragmentation rate, CIRF) were defined successful stone disintegration and used to compare the treatment efficacy. SF and CIRF was evaluated by KUB film & ultrasonography and follow-up up to 90 days after ESWL.
Results：
Noticeable amount of air pockets were observed in the sonogel group but trapped air pocket was nearly not visible in group using icPad. SF and SIRF are statistically similar comparing between group A1 and C1 (69+0.5 % v.s. 61+0.5%) and group A2 and A1(73+0.5 % v.s. 69+0.5%). SF and SIRF are significantly different between group A2 and C1 ( 73+0.5 % v.s. 61+0.5% , p value < 0.0001).
Conclusions:
To our knowledge , this is the first evidence-based observational study showing that a solid conductive interface (ie. icPad) can improve ESWL efficacy in stone disintegration. The use of icPad can achieve successful ESWL treatment with lower number of shockwave hits and lower energy level, which saves time and the life of the lithotripter.