研究目的：泌尿道結石使用體外震波碎石術治療可在各種麻醉下進行，但不是每種麻醉都很理想，而且碎石效果也有差異。不僅因為疼痛的忍受度有所不同，且因震波碎石時，呼吸造成結石移動而失準確。當病人接受第一次體外震波碎石術而效果不理想時需再一步接受較為侵襲性的輸尿管鏡或經皮腎臟鏡手術。為了增加體外震波碎石術的效果及減少後續的侵襲手術，我們發展一種簡單的全身麻醉來控制結石的移動。材料與方法：我們使用氣管內管全身麻醉術執行了44例第二次ESWL (group A)，這些病人都曾有第一次的ESWL失敗。因為此種全身麻醉術可以控制呼吸及結石移動很小，而且我們也使用暫停一分鐘換氣(ventilation)使結石完全靜止，所以擊碎效果很好。在控制組，我們使用靜脈注射fentanyl麻醉，執行了40例第二次ESWL (group B)做為比較，這些病人也都有失敗的第一次ESWL。結果：在group A組的成功率是81.8%，而group B組的成功率是37.5%，p<0.01。結論：體外震波碎石術可以使用氣管內管麻醉術來控制疼痛及結石的移動，及使用一分鐘暫停呼吸（換氣）來達到最佳效果。

Objective: Treatment of urinary calculi with extracorporeal shock wave lithotripsy (ESWL) is performed under various types of anesthesia, but is not well tolerated by all patients. Disintegration rates of the calculi with ESWL vary as well, not only because of pain intolerance but due to stone movement during respiration. When the first ESWL procedure fails to fragment the stones, a patient may have to undergo more-invasive procedures such as ureteroscopic lithotripsy (URSL) or percutaneous nephrolithotomy (PNL) which may increase suffering and morbidity. Accordingly, we have developed a more-effective method of anesthesia to control stone movement during ESWL. Materials and Methods: We performed 44 second-time ESWL procedures with endotracheal general anesthesia on 42 patients for whom had failed the first-time ESWL (group A). One-minute pauses of ventilation to hold the stone absolutely still were made to maximize the effectiveness. In the control group, we performed 40 second-time ESWL procedures using intravenous fentanyl anesthesia on 40 patients for whom had failed the first-time ESWL (group B). Results: The average stone movement in group A was 0.78 cm for renal stones and 0.65 cm for upper ureteral stones. With a 1-minute pause in ventilation, the average stone movement was 0.16 cm for renal stones and 0.1cm for upper ureteral stones. In group B, the average stone movement was 1.45 cm for renal stones and 1.03 cm for upper ureteral stones. The disintegration rate was 81.8% in group A and 37.5% in group B (p<0.01). Conclusions: Endotracheal general anesthesia with one-minute pause in ventilation during ESWL can reduce stone movement and increase the effectiveness of ESWL.