តើម៉ាស៊ីនបំបែកគ្រួសតម្រងនោមជំនាន់ទី ៤ មានប្រសិទ្ធិភាពនឹងវាដំណើរការបាញបំបែកគ្រួសតាមរបៀបយ៉ាងណា?

បានធ្វើបច្ចុប្បន្នភាពចុងក្រោយ៖ ខែ​សីហា 15, 2026

• ប្លក, រូបភាព
• LinkedIn
• សំបុត្រ

Extracorporeal Shockwave Lithotripsy (ESWL) is a minimally invasive treatment for kidney stones. This article explains what the 4th generation of lithotripter technology added over earlier machines. It is written as general education about the technology itself — it does not describe the equipment at any one hospital. For ការណែនាំសម្រាប់អ្នកជំងឺក្រោយ ESWL និង ប្រវត្តិនៃជំនាន់ ESWL ទាំង ៤, សូមមើលអត្ថបទដែលមានតំណភ្ជាប់។.

A note on our own equipment: ESWL at Bangkok Hospital Headquarters is currently performed with a third-generation lithotripter, as a daycare procedure with short-acting intravenous analgesia or light sedation for comfort. I introduced 4th-generation ESWL to Cambodia at Royal Phnom Penh Hospital in 2018, after training at Chang Gung Memorial Hospital in Taiwan — but that machine is not the one in use at BHQ today.

• មជ្ឈមណ្ឌលផ្នែកជម្ងឺប្រព័ន្ធទឹកនោមនៃមន្ទីរពេទ្យបាងកក ប្រទេសថៃ។ កក់លេខរៀងការណាត់ជួបតាម online 02-310-3009 bhquro@bdms.co.th
• មន្ទីរពេទ្យ Samitivej Sriracha ខេត្តឈុនបូរី។ 088-022-1445

តើ​ធ្វើ​ដូចម្តេច អេសអិលអិល ការងារ?

• បច្ចេកវិទ្យា ESWL មានដើមកំណើតជារបកគំហើញមួយក្នុងអំឡុងសង្គ្រាមលោកលើកទី 2 ហើយត្រូវបានកែលម្អតាមរយៈ 4 ជំនាន់។ ជំនាន់នីមួយៗផ្តល់នូវការគ្រប់គ្រងការឈឺចាប់កាន់តែប្រសើរ និងផលវិបាកតិចជាងមុន។
• ក្បាលរលកឆក់ត្រូវបានដាក់ទល់នឹងចំហៀងខ្លួនរបស់អ្នកជំងឺ (តំបន់ដែលតម្រងនោមស្ថិតនៅ)។ ម៉ាស៊ីននេះបង្កើតជីពចររលកឆក់ដែលធ្វើដំណើរឆ្លងកាត់ស្បែក និងបំបែកគ្រួសក្នុងតម្រងនោមទៅជាបំណែកតូចៗ។
• នៅពេលដែលបំណែកថ្មត្រូវបានបំបែករួច លំហូរទឹកនោមជាបន្តបន្ទាប់តាមធម្មជាតិពីតម្រងនោមនឹងបញ្ចេញបំណែកថ្មនោះចេញតាមរយៈការនោមធម្មតា។

What 4th Generation ESWL added over previous generations

• ប្រព័ន្ធតាមដានដោយស្វ័យប្រវត្តិ — 4th-generation machines use an automated targeting system that continuously tracks and locks onto the stone. This helps shockwaves hit the stone accurately and reduces unnecessary energy delivery to surrounding kidney tissue
• Less need for sedation — because less energy reaches tissue around the stone, the procedure is generally better tolerated, and many centres perform it as a daycare treatment with minimal or no sedation
• Higher reported targeting accuracy — manufacturer and comparative reports describe a hit rate of around 98.5% for 4th-generation systems, against roughly 82.6% for 3rd-generation machines
• ផលវិបាកតិចជាងមុន — greater targeting precision means less trauma to surrounding renal tissue

None of this means older machines do not work. A 3rd-generation lithotripter remains an effective, well-established treatment for appropriately selected stones; the practical difference is that patients are given short-acting intravenous analgesia or light sedation for comfort during the session.

ESWL success rates by stone size

The European Association of Urology (EAU) 2020 guidelines recommend ESWL for kidney stones under 2 cm. Success is defined as stone fragments < 4 mm on follow-up imaging. Reported outcomes fall broadly in these ranges:

• ថ្ម < 1 សង់ទីម៉ែត្រ៖ around 84% success
• ថ្ម ១–២ សង់ទីម៉ែត្រ៖ around 77% success
• ថ្ម > 2 សង់ទីម៉ែត្រ៖ around 60% success

Stone size is only one factor. Stone density on CT, its position within the kidney, the patient’s body habitus, and the distance from skin to stone all influence how well any lithotripter performs.

សំណួរដែលសួរជាញឹកញាប់អំពី ESWL ជំនាន់ទី 4

What makes 4th Generation ESWL different from previous generations?

The defining feature of 4th-generation ESWL is its auto-tracking system, which continuously locks onto the kidney stone as it moves with breathing. Reported targeting accuracy is around 98.5%, compared with roughly 82.6% for 3rd-generation machines. Better targeting means less energy reaches the tissue around the stone, which reduces discomfort during the session and allows many centres to treat with minimal or no sedation. Earlier-generation machines remain effective; they simply rely more on operator adjustment and on giving the patient analgesia or light sedation for comfort.

តើ ESWL អាចព្យាបាលគ្រួសក្នុងតម្រងនោមទំហំប៉ុនណា?

The European Association of Urology (EAU) guidelines recommend ESWL for kidney stones under 2 cm. Reported success rates are approximately 84% for stones under 1 cm, 77% for 1–2 cm stones, and 60% for stones over 2 cm, where success is defined as residual fragments under 4 mm at follow-up. Stones larger than 2 cm may require additional sessions or an alternative procedure. Guidelines list percutaneous nephrolithotomy (PCNL) as first-line above 2 cm, but PCNL requires a tract created through the flank into the kidney; Dr. Soarawee’s preference is to attempt retrograde intrarenal surgery (RIRS) with the holmium laser wherever it is feasible, since it reaches the stone through the natural urinary passage with no incision and modern flexible ureteroscopy handles stones of almost any size. Stone density, position and body habitus also affect the result.

Is ESWL painful, and is anesthesia required?

This depends on the generation of machine. General anesthesia is not required for ESWL in either case. With a 4th-generation system, the auto-tracking function limits shockwave energy reaching tissue around the stone, so many centres treat with minimal or no sedation. With a 3rd-generation lithotripter — which is what is used at Bangkok Hospital Headquarters — patients are given short-acting intravenous analgesia or light sedation so the session is comfortable. Either way ESWL is a daycare procedure: patients go home the same day, with no post-anesthetic recovery stay.

ប្រសិនបើអ្នកត្រូវបានគេធ្វើរោគវិនិច្ឆ័យថាមានគ្រួសក្នុងតម្រងនោម ហើយចង់ពិភាក្សាអំពី ESWL ឬជម្រើសនៃការព្យាបាលគ្រួសក្នុងតម្រងនោមផ្សេងទៀត លោកវេជ្ជបណ្ឌិត Soarawee Weerasopone ផ្តល់ជូនការពិគ្រោះយោបល់ជំនាញនៅទីស្នាក់ការកណ្តាលមន្ទីរពេទ្យបាងកក។. កក់ការពិគ្រោះយោបល់. ការណាត់ជួបនៅមន្ទីរពេទ្យ Samitivej Sriracha អាចត្រូវបានរៀបចំដោយទូរស័ព្ទទៅផ្នែកជំងឺប្រព័ន្ធទឹកនោមតាមរយៈលេខ 088-022-1445.

ការបដិសេធ៖ ខ្លឹមសារនេះត្រូវបានសរសេរ និងពិនិត្យដោយលោកវេជ្ជបណ្ឌិត Soarawee Weerasopone ដែលជាគ្រូពេទ្យឯកទេសខាងប្រព័ន្ធទឹកនោមដែលមានវិញ្ញាបនបត្រនៅទីស្នាក់ការកណ្តាលមន្ទីរពេទ្យបាងកក។ វាត្រូវបានបម្រុងទុកសម្រាប់គោលបំណងអប់រំតែប៉ុណ្ណោះ ហើយមិនមែនជាដំបូន្មានផ្នែកវេជ្ជសាស្ត្រទេ។ មិនមានដំបូន្មានផ្នែកវេជ្ជសាស្ត្រ ការធ្វើរោគវិនិច្ឆ័យ ឬវេជ្ជបញ្ជាត្រូវបានផ្តល់ជូនតាមរយៈបណ្តាញផ្ញើសារផ្ទាល់ខ្លួនទេ។ តែងតែពិគ្រោះជាមួយអ្នកជំនាញថែទាំសុខភាពដែលមានសមត្ថភាព មុនពេលចាប់ផ្តើមការព្យាបាលណាមួយឡើយ។.