體外震波一直為用來對結石病患之非侵入性治療方法，近幾年來，震波更被廣泛地應用在骨科上，其臨床治療效果皆相當成功，如骨肌疾病。因此，本研究為應用體外震波於脂肪組織破壞之先驅，即發展出震波消脂技術。
在進行體外實驗中，經由壓力探針量測出豬之脂肪組織在不同操作電壓下聚焦區之壓力。在測試多組實驗後，使用0.873 mJ/mm2高能量密度之震波於脂肪組織內，此能量值對應我們實驗室機器之操作電壓為10kV。每組實驗之後，我們對接受震波後之脂肪組織進行病理檢驗，其中包含福馬林固定、蠟塊包埋以及H&E染色。每份切片檢體受震波破壞之處，經由顯微鏡觀察找出並照相存檔，並且使用3種不同放大倍率(12, 40和100倍) 觀察脂肪細胞在物理上、結構上和組織學上之變化情形，其可看出在接受震波聚焦之特定皮下組織層區域，震波所造成之機械效應和空蝕效應會破壞脂肪組織之細胞膜，且不傷害皮膚表層、周圍之血管以及神經纖維。並發現至少需要650次震波及0.873 mJ/mm2之高能量密度，始可看出脂肪組織明顯之破壞。

Extracorporeal Shock Waves (ESW) are routinely used for non-invasive disintegration of stones within the human body. In the recent years, ESW has other applications such as treatment in orthopedics. It was successful in clinical treatments of musculo-skeletal disorders. Consequently, the study of applying ESW for destroying fat tissue is a pioneer trial in the development of a shockwave-assisted lipotripsy technology.
In in-vitro experiments, pressure sensors were used to measure the pressure field inside a pig’s fat with different operational voltages. High-energy shock waves with an energy flux density of approximately 0.873 mJ/mm2 were applied to the treated fat tissue. This value of energy flux density corresponds to an operation voltage of 10kV in our laboratory. After the ESW treatment, we observed the treated fat tissue with pathological examination through the processes of formalin fixing, paraffin-embedding, and hematoxylin & eosin staining. We observed destructions on the treated fat tissues by a microscope and took pictures of the observed specimens. Three different magnifications (12, 40 and 100 times) were used to examine the physical, structural, and histological variation of adipose cells after shock wave treatment. It was found that, for the treated fat cells, the mechanical effect and cavitation effect caused by shock wave focusing occur in a specific area within the subcutaneous layer, results in broken membranes of the adipose tissues but induces no harm on the skin layer, near-by blood vessels, and peripheral nerve fiber. It was found that the required number of shock waves at least 650 with energy flux density of approximately 0.873 mJ/mm2 is for visible damages on the treated fat tissue.

[1] “Physical Status: The Use and Interpretation of Anthropometry”, WHO Technical Report Series, #854, pp. 9, 1995.
[2] “Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity”, WHO, Geneva, June 1997.
[3] Fischer, A., Fischer, G., “Revised Technique for Cellulitis Fat Reduction in Riding Breeches Deformity”, Bulletin of the International Academy Cosmetic Surgery, Vol. 2, pp. 40-41, 1977.
[4] Illouz, Y., “Body Contouring by Lipolysis: A 5-year Experience with Over 3000 Cases”, Plastic and Reconstructive Surgery, Vol. 72, No.5, pp. 511-524, 1983.
[5] Klein, J. A., “The Tumescent Technique for Liposuction Surgery”, American J. Cosmetic Surgery, Vol. 4, pp. 236-267, 1987.
[6] Petty, R. W. and Kantrowitz, A., “The Production and Stability of Converging Shock Waves”, J. Applied Physics, Vol. 22, No. 7, pp. 878-886, 1951.
[7] Chaussy, C., Schmiedt, E., Jocham, D., Schuller, J., Brendel, H., and Liedl, B., “Extracorporeal Shock-Wave Lithotripsy (ESWL) for Treatment of Urolithiasis”, Urology, Vol. 93, pp. 59, 1984.
[8] Chaussy, C., Schmiedt, E., Jocham, D., Brendel, W., Forssmann, B., and Walther, W.”, First Clinical Experience with Extracorporeally Induced Destruction of Kidney Stones by Shock Waves,” J. Urology, Vol. 127, pp. 417-420, 1982.
[9] Hunter, P. T., Finayson, B., Robert, J., Hirko, W. C., Voreck, R. W., Scott W., Mohammed, N., “Measurement of Shock Wave Pressures Used for Lithotripsy”, J. Urology, Vol. 136, pp. 733-738, 1986.
[10] Chuong, C. J., “Different Stone Damage Modes during Lithotripsy Shock Wave Delivery”, Biomechanics Symposium, pp. 5-8, 1989.
[11] Hilgert, J., “Ultrasonic Cleaning Primer”, Brason Ultrasonic Corp., 1995.
[12] Crum, L. A., “Comments on the Evolving Field of Sonochemistry by a Cavitation Physicist”, Ultrasonics Sonochemistry, Vol. 2, No.2, 1995.
[13] Leighton T. G., “The Acoustic Bubble”, Academic Press, London, 1994.
[14] Crum, L. A., “Cavitation Micro-Jets as a Contributory Mechanism for Renal Disintegration in ESWL”, J. Urology, Vol. 140, pp.1587-1590, 1988.
[15] Chuong, C. J., Zhong, P. and Glenn, P. M., “A Comparison of Stone Damage Caused by Different Methods of Shock Wave Generation”, J. Urology, Vol. 148, pp.200-205, July, 1988.
[16] Sturtevant, B., “Shock Wave Physics of Lithotripters”, in Smith’s Textbook of Endourology, Quality Medical Publishing, Inc., pp. 529-552, 1996.
[17] Wang, C. J., Pai, C. H., Huang, S. Y., “Shock Wave Enhanced Neovascularization at the Tendon Bone Junction, an Experiment in dog Model”, 3rd Congress of the International Society for Musculoskeletal Shockwave Therapy (ISMST), Naples, June 1–3, pp. 96, 2000.
[18] Wang, C. J., Pai, C. H., Huang, S. Y., “Pathomechanism of Shock Wave Induced Injuries on Femoral Artery, Vein and Nerve,” 3rd Congress of the International Society for Musculoskeletal Shockwave Therapy (ISMST), Naples, June 1–3, pp. 95, 2000.
[19] Wang, F.S., Yang, K.D., Wang, Y., Wang, C. J., “Shock Wave Enhanced Growth Factor TGF-B,” 3rd Congress of the International Society for Musculoskeletal Shockwave Therapy (ISMST), Naples, June 1–3, pp. 99, 2000.
[20] Brown, S., “Director of Plastic Surgery Research”, Published by Ultrashape Ltd. 30 Habarzel Street Tel Aviv 67910 Israel, 2005.
[21] Brown, S., “What Happens to the Fat After Treatment With the UltraShape Device”, Published by Ultrashape Ltd. 30 Habarzel Street Tel Aviv 67910 Israel, 2005.
[22] Shung, K.K., Smith, M. B., Tsui, B., “Principles of Medical Imaging”, Academic Press, 1992.
[23] Williams, Jr. J. C., Stonehill, M. A., Colmenares, K., Evan, A. P., Andreoli, S. P., Cleveland, R. O., Bailey, M. R., Crum, L. A., McAteer, J. A., “Effect of Macroscopic Air Bubbles on Cell Lysis by Shock Wave Lithotripsy in Vitro”, Ultrasound in Medicine & Biology. Vol. 25, No. 3, pp. 473-479, March 1999.
[24] Sapozhnikov, O. A., Khokhlova, Bailey, V. A., Crum, L. A., “Effect of Overpressure and Pulse Repetition Frequency on Cavitation in Shock Wave Lithotripsy”, J. Acoustic Soc Am. Vol. 112, No. 3, Part 1, pp. 1183-1195, September, 2002.
[25] Wilner, J. M., Strash, W. W., “Extracorporeal Shockwave Therapy for Plantar Fasciitis and Other Musculoskeletal Conditions Utilizing the Ossatron--an update”, Clin Podiatr Med. Surgery Vol. 21, No. 3, pp. 441-447, July, 2004.
[26] Harniman, E., Carette, S., Kennedy, C., Beaton, D. J., “Extracorporeal Shock Wave Therapy for Calcific and Noncalcific Tendonitis of the Rotator Cuff: a Systematic Review”, Hand Ther., Vol. 17, No. 2, pp.132-151, 2004.
[27] Speed, C. A.., “Extracorporeal Shock Wave Therapy in the Management of Chronic Soft-tissue Conditions”, J. Bone Joint Surgery Br, Vol. 86, No. 2, pp. 165-171, March, 2004.
[28] Bisset, L., Paungmali, A., Vicenzino, B., Beller, E., “A Systematic Review and Meta-analysis of Clinical Trials on Physical Interventions for Lateral Epicondylalgia”, Br J. Sports Med., Vol. 39, No. 7, pp. 411-422, July, 2005.
[29] Manousakas, I., Wan, L. R., Liang, S. M.., "Study on the Focusing Pressure of the Shock Wave by Using the Medium of RO Water", Annual Symp. Biomed. Eng. Soc., 2005.
[30] Michel, H. R., Lynn, J. R., Gordon, I. K., “Histology: a Text and Atlas,” 3rd ed., Williams & Wilkins, Baltimore, Maryland 21202, USA, c1995.
[31] 戴興邦，尤芳忞，楊智光，梁勝明，蒲永仁，郭昭霖，陳天送，陳進興，”中華民國醫學工程科技研討會論文集”，pp. 256-263，1998。
[32] 王嘉輝，“水電式體外震波碎石機電極間距自動控制系統設計和性能評估”， 國立成功大學航空太空工程研究所，碩士論文，2001。
[33] 萬龍瑞，“具結石粉碎分析功能之高效率震波產生器研究”，國立成功大學航空太空工程研究所，碩士論文，2003。
[34] 郭志祥，“水電式汽泡產生器的特性研究”，國立成功大學機械工程研究所，碩士論文，2003。
[35] 周傑鴻，“疾用之震波產生器之設計與性能評估”，國立成功大學航空太空工程研究所，碩士論文，2004。
[36] 魯祿康，“體外震波碎石機改良結石追蹤系統之性能評估”，國立成功大學航空太空工程研究所，碩士論文，2004。