石材疗法的演变：从战区到高科技疗愈

最后更新： 8 月 17, 2026

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欢迎踏上这段探索现代泌尿外科最具变革性技术之一——体外冲击波碎石术（ESWL）的历史与科学之旅。作为一名专攻肾结石治疗的认证泌尿科医生，我想向您讲述一个战时观察如何演变为当今我们所提供的最精妙的非侵入性治疗手段之一。.

本文摘自我于2018年11月17日在金边皇家泌尿外科研讨会上发表的正式演讲。那次研讨会是我职业生涯中一个意义非凡的里程碑——在那时，我们将医学创新的历史渊源与我如今在曼谷医院总院和萨米提维斯里拉查医院为患者提供的尖端解决方案紧密联系在了一起。.

Before the History: When a Stone Becomes an Emergency

This article is about technology, and technology is the least urgent part of stone disease. Before reading on, it is worth knowing which stone situations cannot wait, because the answer to them is not a lithotripter appointment:

• Fever or shaking chills with flank pain. This suggests an infected, obstructed kidney — the true emergency of stone disease. It needs urgent drainage of the kidney, not antibiotics alone, and it can become life-threatening within hours.
• Passing little or no urine, or severe pain in a man with a single functioning kidney or a transplanted kidney.
• Pain with persistent vomiting that prevents you keeping fluids down.
• Suspected stone in pregnancy, which needs assessment by a team rather than a standard pathway.

In Thailand the emergency number is 1669. Everything below assumes you are not in one of these situations.

冲击波究竟是什么？

To understand how we break kidney stones without a single incision, we must first understand the physics of the shockwave. In scientific terms, a shockwave is a sharp change of pressure in a narrow region traveling through a medium such as air or water. These waves are typically caused by explosions or by bodies moving faster than the speed of sound.

In urology, we harness this energy and aim it with precision. Think of it like a focused beam of sound energy: much like a magnifying glass focuses sunlight onto a single point to create heat, an ESWL machine focuses shockwaves onto a kidney stone to create mechanical stress, eventually shattering the stone into dust or small fragments that can be passed naturally in the urine.

一段令人惊讶的历史：从战场到医院

体外冲击波碎石术（ESWL）的发展历程是“双重用途技术”的经典范例——即一个领域的发现彻底改变了另一个领域。.

• 第二次世界大战的联系： 二战期间，人们观察到，在水下深水炸弹爆炸附近的海员和士兵，即使没有明显的外伤，也遭受了严重的肺部损伤。这证明了冲击波能够通过水和人体传播，影响内部结构。.
• 《突破》（1980）：数十年来对高能物理学的研究最终促成了一项医学突破。1980年2月7日，德国成功实施了首例使用第一代体外冲击波碎石机对人类进行治疗的手术。这一事件彻底改变了泌尿外科的发展，将曾经需要进行的大型开腹手术转变为非侵入性治疗。.

The Four Generations of ESWL

The technology has evolved rapidly since 1980. Each generation of machines has aimed to make the treatment safer, more comfortable, and more accurate. One caution before the list, because it is easy to read a story of generations as a story of steadily better results: what improved most across the generations was comfort, size, cost and targeting. Stone clearance itself has not improved in the same straight line, and the characteristics of your stone matter more than the age of the machine.

1. The First Generation: The Water Bath Era

早期机器十分庞大。工作时，病人必须浸没在装满水的大浴缸中，以便冲击波能从发电机传导到身体。其缺点非常显著：这些机器价格极其昂贵且体积庞大，焦点区域（能量击中的区域）很宽，因此不够精确，病人需要全身麻醉，并且通常需要住院治疗。.

2. The Second Generation: The Dry Patient

Engineers replaced the giant water tub with a small water-filled cushion or bellows pressed against the patient’s skin. The patient stayed dry, and the focal zone became tighter and more accurate. Some treatments could be done under local anesthesia — but the machines remained large and still required significant radiation exposure for stone targeting.

3. 第三代：紧凑高效

These machines became much smaller and more mobile. However, they still relied heavily on X-ray (fluoroscopy) for targeting, meaning patients were exposed to radiation. Furthermore, the patient’s breathing caused the kidney stone to move up and down with each respiration, making it difficult to maintain a perfect hit rate on the stone. This is the generation in use at Bangkok Hospital Headquarters today, and it remains a thoroughly established treatment — the large majority of the world’s published ESWL evidence was generated on machines of this type.

4. The Fourth Generation

This generation represents a real advance in targeting and patient comfort. I introduced Cambodia’s first 4th-generation lithotripter at Royal Phnom Penh Hospital in 2018, after training on the system at Chang Gung Memorial Hospital in Taiwan. At Bangkok Hospital Headquarters, ESWL is currently performed using a 3rd-generation lithotripter. The improvements of the 4th generation are these:

• Automated stone localization: the system assists in finding and holding the target.
• Radiation-free targeting: ultrasound rather than X-ray can be used to locate the stone, so a session can be completed without radiation exposure. In practice X-ray is still used in some cases, for example where the stone is not clearly seen on ultrasound.
• Respiratory tracking: the ultrasound system follows the stone as it moves with the patient’s breath, so more of the shockwaves land on the target rather than on surrounding tissue.
• Less need for anesthesia: many patients tolerate treatment with little or no analgesia and return home the same day. This is about comfort during the session; it does not by itself mean more stones are cleared.

什么决定成功？

Whichever generation of lithotripter is used, whether a stone breaks depends far more on the stone than on the machine:

因式分解	描述
Stone hardness	Not all stones are alike. CT scanning measures stone density in Hounsfield Units. Dense stones — calcium oxalate monohydrate and cystine in particular — resist shockwaves and may not fragment at all, whichever machine is used.
Stone location	Stones in the kidney or upper ureter generally do better than those in the lower pole, where fragments must travel uphill to leave the kidney and often simply stay there.
Stone size	Stones under 10 mm do best. Above 10 mm, a single session clears fewer stones and a second treatment is more often needed.
Body habitus	The distance from skin to stone matters. Where that distance is large, the shockwave arrives with less energy and success falls — which is why ESWL is not the right choice for every patient.

A note on the success figures quoted for ESWL, including on this site in the past. Published rates for stones under 10 mm are often given as roughly 85–90%, but those numbers move a great deal depending on what is being counted. Being stone-free on a CT scan is a far stricter test than having no fragment larger than 4 mm, and studies use both. Density, location and skin-to-stone distance shift the figure further. The honest way to use a published rate is as a starting point for a conversation about your own stone, not as a promise.

What ESWL Asks of You: Risks and Aftermath

Non-invasive does not mean without consequence, and a history of the technology would be incomplete without saying what the treatment actually involves for a patient. Expected effects in the days afterwards include blood in the urine, bruising or tenderness of the skin over the treated side, and colicky pain as fragments make their way down the ureter — that pain can be worse than the original stone, and it is normal rather than a sign of failure.

The complications worth knowing about are:

• Steinstrasse — literally a street of stones: fragments lining up and blocking the ureter. Increasing pain, or any pain accompanied by fever, after treatment needs assessment rather than waiting.
• 感染性, including sepsis from bacteria released as the stone breaks up. This is why a urine infection is treated before treatment, never during it.
• Bleeding around the kidney (perirenal haematoma) — uncommon, and more likely with uncontrolled blood pressure or a bleeding tendency.
• Incomplete fragmentation, needing a second session or a change of plan to ureteroscopy.

ESWL is not suitable for everyone. It is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation that has not been managed beforehand, where there is an obstruction below the stone that would prevent fragments passing, and where an aortic or renal artery aneurysm sits in the shockwave path. Whether you can safely pause a blood thinner is a decision for the doctor who prescribed it, together with your urologist — never a decision to make on your own.

What happens after treatment is set out in detail in my patient instructions for 3rd-generation ESWL, which is the machine used at Bangkok Hospital Headquarters. And because breaking a stone is not the same as solving the problem, the more important half of stone care is preventing the next one — and for one stone type in particular, medication can dissolve the stone rather than break it.

最后的想法

The evolution of ESWL — from a wartime observation to a 4th-generation tracking system — is a testament to the power of medical innovation. My presentation in 2018 at Royal Phnom Penh Hospital was, in many ways, a celebration of this progress. But the lesson I took from it, and still hold, is that the machine is the least interesting variable. Whichever generation of lithotripter is used, ESWL remains a non-invasive, same-day treatment that allows most patients to return to normal life quickly — and careful patient selection matters far more than the age of the equipment. At Bangkok Hospital Headquarters, ESWL is performed using a 3rd-generation lithotripter, with candidates selected on the basis of stone size, location, density and body habitus. For stones that ESWL cannot handle well, flexible ureteroscopy with holmium laser (RIRS) is generally the better answer.

If you are dealing with kidney stones and would like to discuss which treatment is right for you, Dr. Soarawee Weerasopone provides specialist kidney stone care 在 曼谷医院总部 and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. For any enquiry about the cost of consultation or treatment, please contact the hospital directly — Bangkok Hospital at bhquro@bdms.co.th, or Samitivej Sriracha on 088-022-1445.

冲击波碎石术 (ESWL) 常见问题解答

什么是 ESWL？它是如何击碎肾结石的？

ESWL（体外冲击波碎石术）利用体外产生的聚焦冲击波将肾结石击碎成小碎片。冲击波穿过皮肤和组织，将能量集中在结石上，使其碎裂成足够小的碎片，可以通过尿液自然排出。.

What are the risks of ESWL, and when should I seek help after treatment?

Blood in the urine, skin tenderness over the treated side and colicky pain as fragments pass are expected in the days afterwards. The complications to know about are steinstrasse (fragments blocking the ureter), infection including sepsis, bleeding around the kidney, and incomplete fragmentation needing a further session. Seek care urgently for fever or shaking chills, pain that is escalating rather than settling, persistent vomiting, or passing little or no urine. In Thailand the emergency number is 1669.

Who should not have ESWL?

ESWL is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation not managed in advance, where an obstruction below the stone would stop fragments passing, and where an aortic or renal artery aneurysm lies in the shockwave path. Very dense stones and a large skin-to-stone distance also make ESWL a poor choice, and flexible ureteroscopy with holmium laser is often better in those situations. Never stop a blood thinner on your own — that decision belongs to the doctor who prescribed it.

体外冲击波碎石术会痛吗？是否需要麻醉？

ESWL is generally well tolerated and is performed as a same-day procedure. How much pain relief is needed depends partly on the machine: with 4th-generation systems many patients need no anesthesia at all, while with 3rd-generation lithotripters — including the one used at Bangkok Hospital Headquarters — short-acting intravenous analgesia or light sedation is commonly given. In either case, patients normally return home the same day.

2厘米以下的肾结石最适合体外冲击波碎石术（ESWL）治疗。

Stones under 10 mm respond best. Published success rates for this group are often quoted around 85–90%, but the figure depends heavily on how success is defined — being completely stone-free on CT is a much stricter test than having no fragment above 4 mm — and on stone density, position and skin-to-stone distance. Stones above 10 mm may still respond but more often need a second session or a different approach.

现代体外冲击波碎石术 (ESWL) 是否仍然使用 X 射线辐射？

It depends on the generation of the machine. Fourth-generation systems can localize the stone with ultrasound and complete a session without X-ray, although fluoroscopy is still used in some cases where the stone is not clearly visible. Third-generation lithotripters — including the one used at Bangkok Hospital Headquarters — rely on X-ray fluoroscopy for targeting, although exposure is brief and kept as low as reasonably achievable, and the dose is comparable to routine diagnostic imaging.

Is a newer machine always better?

Not in the way the word generation suggests. What improved most across the four generations was patient comfort, machine size and cost, and the accuracy of targeting. Stone clearance did not improve along the same straight line, and it depends far more on the density, size, position and depth of your particular stone. A well-selected patient on a 3rd-generation machine will do better than a poorly selected one on a 4th-generation machine.

免责声明 This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. No diagnosis, advice or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting, stopping or changing any medical treatment.