Mammotome旋切术治疗乳腺良性肿瘤76例

【目的】探讨Mammotome旋切系统在乳腺良性疾病诊治中的应用。【方法】2005年9月至2007年12月对76例91处乳腺病灶行超声引导下Mammotome微创旋切术，并进行回顾性分析及评价其在乳腺疾病诊治中的应用价值。【结果】所有病灶均成功切除。76例91处乳腺病灶中，乳腺纤维腺瘤37例（47处），乳腺腺病25例（27处），乳腺腺病伴纤维腺瘤形成11例（14处），乳腺癌3例。【结论】Mammotome微创旋切系统可明确诊断可疑病灶，完整切除乳腺良性病灶，操作简易，创伤小，安全，美容效果好。     

甲状腺弥散性病变合并甲状腺癌应用超声诊断的价值分析

目的:探究在甲状腺弥散性病变合并甲状腺癌患者中应用超声诊断的价值分析。方法:选取我院收治的50例甲状腺弥散性病变合并可疑结节患者作为本次研究对象,患者治疗时间为2018年6月至2019年12月,均在超声检查的指引下进行穿刺性活检,并将诊断结果与病理诊断结果进行对比分析,判断超声诊断的准确性。结果:在50例患者的超声检查中,共检查出病灶69处,其中恶性病灶49处、良性病灶20处,随后经手术病理诊断中,诊断出现病灶74处,其中恶性病灶50处,良性病灶24处,病灶检出率为93.24%(69/74),阳性预期值为98.00%(49/50),阴性预期值为83.33%(20/24)。结论:在针对于甲状腺弥散性病变合并甲状腺癌患者的检查中,采用超声诊断能够有效提高疾病诊断的准确率,检测出其特征性的影像,为随后的治疗提供依据,效果确切显著。     

高频彩色超声在乳腺Mammotome微创旋切系统中的应用

目的:探讨高频彩色超声在乳腺微创手术旋切系统中的应用价值。方法:对780例乳腺良性实性肿块女性患者,于术前行乳腺病灶处高频超声探查,标记定位。在超声引导下行乳腺微创旋切术。结果:在超声引导下直径<3.0 cm的乳腺实性肿块被一次性切除。结论:超声引导下乳腺微创手术可在损伤极小的情况下切除病灶。     

微创活检在乳腺肿物诊断中的应用

目的：用微小介入的方法针取乳房组织进行活检,让医师不用手术就能取得足量乳房组织进行确定诊断。方法：用Mammotone微创乳房肿块活检诊断系统进行取材,将探针单次置入乳房的病灶中利用该系统的真空抽吸辅助装置和特殊的旋转设计,将病灶吸附于管腔内,再用传送装置将管状刀送入管腔内,将病灶取出。结果：61例病人,75处病灶中,恶性11处,良性64处,其中纤维腺瘤28处;乳腺增生或增生性腺瘤36处。34处小于2cm病灶被完全清除,41处病灶均经手术切除并复送病检,与取材吻合率为100%。结论：经皮微创穿刺乳房肿块活检是目前定性诊断乳腺肿块病变的理想方法,在临床实际工作中根据具体条件和需要与传统方法选择应用。     

超声引导下麦默通微创旋切系统在乳腺不可触及病灶中的临床应用价值

目的探讨超声引导下麦默通微创旋切系统在乳腺不可触及病灶中的临床应用价值。方法选择我院2013年1月~2015年1月收治的女性患者40例,共有不可触及病灶或者肿块55处,将其随机分成试验组(20例患者共30处乳腺不可触及病灶)和对照组(20例患者共25处乳腺肿块),对照组患者给予传统开放式手术治疗,试验组患者给予超声引导下麦默通微创旋切术治疗。对两组患者的临床治疗情况进行对比分析。结果试验组患者的切口长度、愈合时间、术中出血量、术后瘢痕大小和术后满意度显著优于对照组患者,两者比较差异有统计学意义(P<0.05)。结论在乳腺不可触及病灶旋切中,应用超声引导下麦默通微创旋切系统,具有微创、定位准确以及美观等特点,值得临床推广和应用。     

超声造影在剖宫产后切口妊娠诊断中的临床应用价值

目的探讨超声造影在剖宫产后切口妊娠诊断中的应用价值。方法对9例常规超声诊断为剖宫产切口妊娠的患者行超声造影检查,比较二维超声、彩色多普勒超声及超声造影检查结果。结果二维超声、超声造影检查均可显示病灶部位、大小;彩色多普勒超声显示8例病灶内无血流信号,1例有血流信号。7例剖宫产后切口处病灶与肌壁界限二维超声显示不清者超声造影剂灌注可判断子宫浆膜层和肌层的完整性,并可辨别病灶与浆膜、肌壁的关系。结论超声造影可为剖宫产切口处妊娠诊断提供更丰富的信息。     

超声在乳腺疾病微创诊疗中的应用

目的使用Mammotome乳腺微创旋切技术对乳腺病灶进行组织学活检和切除，评价超声在此微创诊疗中的作用。方法36例女性患者36处乳腺病灶在超声引导下行微创旋切术，超声动态实时监测切除全过程，所有切除组织均送病理学检查。结果36例36处病灶中，临床诊断33例良性病灶均被Mammotome微创旋切切除，疑为乳腺癌的3例仅行部分切除活检，所有操作无一例失败，均获得明确诊断。除3例疑为乳腺癌患者外，其余病灶在切除后1周、1个月和3个月行超声检查和临床触诊均未在原手术病灶区发现异常。结论超声引导下乳腺病灶微创旋切术是一项简便、安全、有效的技术，具有良好的临床应用前景。     

超声引导穿刺在普通外科中的应用

目的　探讨高频超声在乳腺隐匿性病灶检出、超声引导穿刺定位切除活检和乳腺囊肿穿刺治疗的应用价值。同时介绍腹腔脓肿与积液的超声引导穿刺引流,超声引导PTCD。方法　1993年至今共检出乳腺隐匿性病灶250处,并在超声引导下作穿刺定位病灶切除术。对30处乳腺囊肿在超声引导下作穿刺治疗。5例腹腔脓肿、积液患者在超声引导下作穿刺引流。4例梗阻性黄疸患者在超声引导下行PTCD。结果　高频超声对乳腺隐匿性肿瘤诊断符合率为90%。同时检出9例隐匿性乳腺癌。5例腹腔脓肿、积液患者4例通过穿刺引流治愈。4例PTCD者3例引流成功。结论　超声为乳腺隐匿性病灶的检出、手术定位和囊肿穿刺治疗提供了有效手段。腹腔积液或脓肿超声下穿刺引流是一有效的非手术治疗,超声为PTCD提供了又一有效的引导方法。     

超声诊断膝关节软骨退行性变的影响因素分析

目的 分析超声诊断膝关节软骨退行性变(退变)的一些影响因素.方法 选择行膝关节镜手术患者36例37个膝关节及关节置换术患者4例4个膝关节,共41个膝关节.术前1周行超声检查,超声诊断结果与关节镜或大体标本肉眼所见结果对比.对超声误诊、漏诊病例进行回顾性分析.结果 本组234处病灶,超声诊断真阳性病灶87处,假阳性病灶8处,假阴性病灶47处,真阴性病灶92处,诊断敏感性、特异性、准确性分别为64.9%、92.0%、76.5%.超声对软骨退变的分期与关节镜分期相关(r=0.703,P<0.01),但有59处病灶(59/234,25.2%)两者分期不符.影响超声诊断准确性的因素主要包括(1)病变部位,(2)病变程度,(3)临床治疗过程,(4)一些与超声成像原理有关的一般性影响因素.结论 超声检测膝关节软骨退变操作较复杂,影响因素也多.正确认识这些因素,有助于更好地理解声像图,避免漏诊误诊.     

肝癌射频消融术后超声造影引导下无水乙醇治疗肝癌的临床价值

目的：研究与常规超声引导相比较,超声造影(CEUS)引导下无水乙醇治疗射频消融术(RFA)后残存的肝癌有无优越性。方法：61例原发性肝癌的患者RFA术后行无水乙醇注射进行补充治疗,根据引导方式不同分为治疗组和对照组,治疗组运用超声造影引导方式,对照组采用常规超声引导方式,术后1个月对治疗病灶进行超声造影及增强CT的评价。结果：治疗组30个病灶,28个病灶达到完全灭活,2个病灶存有残存活性区达到部分灭活。对照组31个病灶,22个病灶达到完全灭活,9个病灶达到部分灭活。两者有统计学差异,(P＜0.05)。结论：运用超声造影引导可以有效的提高肝癌RFA术后无水乙醇治疗肝癌的疗效。     

Therapeutic ultrasound: its application in drug delivery

Ultrasound is best known for its imaging capability in diagnostic medicine. However, there have been considerable efforts recently to develop therapeutic uses for it. The purpose of this review is to summarize some of the recent advances made in the area of therapeutic ultrasound as they relate to drug delivery. In particular, this review will focus on the applications of ultrasound to enhance the delivery and effect of three distinctive therapeutic drug classes: chemotherapeutic, thrombolytic, and gene-based drugs. In addition, ultrasound contrast agents have been recently developed for diagnostic ultrasound. New experimental evidence suggests that these contrast agents can be used as exogenous cavitation nuclei for enhancement of drug and gene delivery. Thus, brief review of this new class of agents and their roles in drug delivery will also be provided. By comparison to diagnostic ultrasound, progress in therapeutic use of ultrasound has been somewhat limited. The recent successes in ultrasound-related drug delivery research positions ultrasound as therapeutic tool for drug delivery in the future.     

Ultrasound-Responsive Cavitation Nuclei for Therapy and Drug Delivery

Therapeutic ultrasound strategies that harness the mechanical activity of cavitation nuclei for beneficial tissue bio-effects are actively under development. The mechanical oscillations of circulating microbubbles, the most widely investigated cavitation nuclei, which may also encapsulate or shield a therapeutic agent in the bloodstream, trigger and promote localized uptake. Oscillating microbubbles can create stresses either on nearby tissue or in surrounding fluid to enhance drug penetration and efficacy in the brain, spinal cord, vasculature, immune system, biofilm or tumors. This review summarizes recent investigations that have elucidated interactions of ultrasound and cavitation nuclei with cells, the treatment of tumors, immunotherapy, the blood–brain and blood–spinal cord barriers, sonothrombolysis, cardiovascular drug delivery and sonobactericide. In particular, an overview of salient ultrasound features, drug delivery vehicles, therapeutic transport routes and pre-clinical and clinical studies is provided. Successful implementation of ultrasound and cavitation nuclei-mediated drug delivery has the potential to change the way drugs are administered systemically, resulting in more effective therapeutics and less-invasive treatments.     

Therapeutic Ultrasound Parameter Optimization for Drug Delivery Applied to a Murine Model of Hepatocellular Carcinoma

Ultrasound and microbubble (USMB)-mediated drug delivery is a valuable tool for increasing the efficiency of the delivery of therapeutic agents to cancer while maintaining low systemic toxicity. Typically, selection of USMB drug delivery parameters used in current research settings are either based on previous studies described in the literature or optimized using tissue-mimicking phantoms. However, phantoms rarely mimic in vivo tumor environments, and the selection of parameters should be based on the application or experiment. In the following study, we optimized the therapeutic parameters of the ultrasound drug delivery system to achieve the most efficient in vivo drug delivery using fluorescent semiconducting polymer nanoparticles as a model nanocarrier. We illustrate that voltage, pulse repetition frequency and treatment time (i.e., number of ultrasound pulses per therapy area) delivered to the tumor can successfully be optimized in vivo to ensure effective delivery of the semiconducting polymer nanoparticles to models of hepatocellular carcinoma. The optimal in vivo parameters for USMB drug delivery in this study were 70 V (peak negative pressure = 3.4 MPa, mechanical index = 1.22), 1-Hz pulse repetition frequency and 100-s therapy time. USMB-mediated drug delivery using in vivo optimized ultrasound parameters caused an up to 2.2-fold (p < 0.01) increase in drug delivery to solid tumors compared with that using phantom-optimized ultrasound parameters.     

基于STC12C5S60S2单片机经皮给药系统的设计

背景:经皮给药技术为蛋白质多肽类药物的导入提供了一种方便有效的方式。目的:研制一种基于微控制器的经皮给药系统,实现药物经皮无创导入的同时维持药物的活性,提高药物的生物利用度。方法:经皮给药系统以微控制器为核心,采用电致孔导入技术,电离导入技术和超声波导入技术从不同角度克服皮肤屏障,促进药物经皮吸收,在软硬件上合理的设计实现3种机制的协同作用,提高药物导入的效率。结果与结论:试制出经皮给药系统样机,该系统操作简便,以无创的方式经皮给药可以提高患者的依从性,通过各治疗参数的调节,可用于多种药物的经皮导入,为实现个体化治疗提供可能。     

Encapsulated ultrasound microbubbles: therapeutic application in drug/gene delivery.

Encapsulated gas microbubbles are well known as ultrasound contrast agents for medical ultrasound imaging. Nonetheless, not only do these microbubbles help to image, but they can also be used as drug/gene carriers. The microbubbles as drug/gene carriers have an average size less than that of red blood cells, i.e. they are capable of penetrating even into the small blood capillaries and releasing drug and genes under the action of ultrasound field. The application of ultrasound and microbubbles to targeted drug and gene delivery has been the subject of intense experimental research. Under exposure of sufficiently high-amplitude ultrasound, these targeted microbubbles would rupture, spewing drugs or genes, which are contained in its encapsulating layer, to targeted cells or tissues. Recently, targeting ligands are attached to the surface of the microbubbles (i.e. targeted-microbubbles), which have been widely used in cardiovascular system and tumor diagnosis and therapy. In this paper, the characterization of novel targeted ultrasonic contrast agents or microbubbles and their potential applications in drug delivery or gene therapy are reviewed.     

Sonic activation of molecularly-targeted nanoparticles accelerates transmembrane lipid delivery to cancer cells through contact-mediated mechanisms: implications for enhanced local drug delivery

Liquid perfluorocarbon nanoparticles serve as sensitive and specific targeted contrast and drug delivery vehicles by binding to specific cell surface markers. We hypothesized that application of acoustic energy at diagnostic power levels could promote nanoparticle-associated drug delivery by stimulating increased interaction between the nanoparticle's lipid layer and the targeted cell's plasma membrane. Ultrasound (mechanical index = 1.9) applied with a conventional ultrasound imaging system to nanoparticles targeted to alpha(v)beta3-integrins on C32 melanoma cancer cells in vitro produced no untoward effects. Within 5 min, lipid delivery from nanoparticles into cell cytoplasm was dramatically augmented. We also demonstrate the operation of a potential physical mechanism for this effect, the acoustic radiation force on the nanoparticles, which may contribute to the enhanced lipid delivery. Accordingly, we propose that local delivery of lipophilic substances (e.g., drugs) from targeted nanoparticles directly into cell cytoplasm can be augmented rapidly and safely with conventional ultrasound imaging devices through nondestructive mechanisms.     

Superselective Drug Delivery Using Doxorubicin-Encapsulated Liposomes and Ultrasound in a Mouse Model of Lung Metastasis Activation

Conventional treatment of lymph node metastasis involves dissection of the tumor and regional lymph nodes, but this may cause activation of latent metastatic tumor cells. However, there are few reports on animal models regarding the activation of latent metastatic tumor cells and effective methods of treating activated tumor cells. Here, we report the use of a superselective drug delivery system in a mouse model of lung metastasis in which activated tumor cells are treated with doxorubicin-encapsulated liposomes (DOX-LP) and ultrasound. The axillary lymph node was injected with DOX-LP and exposed to ultrasound so that the released DOX would be delivered from the axillary lymph node to the metastatic lung via the subclavian vein, heart and pulmonary artery. The size of the DOX-LP was optimized to a diameter of 460?nm using indocyanine green-encapsulated liposomes, and the ultrasound intensity was 0.5 W/cm². We found that compared with DOX or DOX-LP alone, the superselective drug delivery system was effective in the treatment of metastasis in both the lung and axillary lymph node. We anticipate that this superselective drug delivery system will be a starting point for the development of new techniques for treating lung metastasis in the clinical setting. Furthermore, the superselective drug delivery system may be used to screen novel drugs for the treatment of lung cancer and investigate the mechanisms of tumor cell activation after resection of a primary tumor or lymph nodes.     

Sonodynamic Therapy Based on Combined Use of Low Dose Administration of Epirubicin-Incorporating Drug Delivery System and Focused Ultrasound

Sonodynamic therapy (SDT) is currently considered as one of the promising minimally invasive treatment options for solid cancers. SDT is based on the combined use of a sonosensitizer drug and high-intensity focused ultrasound (HIFU) to produce cytotoxic reactive oxygen species (ROS) in and around neoplastic cells. Anthracycline drugs, including epirubicin (EPI), have been well known as effective sonosensitizers after interaction with focused ultrasound. Recently a new anticancer drug delivery system (DDS), NC-6300, has been developed that comprises EPI through an acid–labile hydrazone bond. In previous in vivo studies, NC-6300 showed basic drug safety and an excellent concentration property of EPI, and recently has been tested in clinical trials. For realizing minimally invasive cancer treatment, the present study demonstrated the effectiveness and feasibility of DDS-based SDT, which combined a small dose of NC-6300 and low energy of HIFU in mouse models of colon cancer and pancreatic cancer.     

The Combination of Intralymphatic Chemotherapy with Ultrasound and Nano-/Microbubbles Is Efficient in the Treatment of Experimental Tumors in Mouse Lymph Nodes

Intravenous chemotherapy is a therapeutic option for the treatment of lymph node metastasis, but the drugs often have difficulty accessing the lymphatic system. The aim of this study was to determine whether the combination of intralymphatic chemotherapy with ultrasound and nano-/microbubbles is active against tumors in mouse lymph nodes. Intralymphatic chemotherapy in mice with lymph nodes containing tumors was found to have a marked anti-tumor effect, compared with intravenous administration, and the addition of ultrasound combined with nano-/microbubbles enhanced the effect of the anti-cancer drug, but only when the drug was administered intralymphatically. Furthermore, decreases in the volumes and blood vessel densities of tumor-bearing lymph nodes are reliable measures of therapeutic effect, confirmed by histopathological evaluation. The main conclusion is that combining ultrasound with nano-/microbubbles and intralymphatic chemotherapy improves drug delivery to the lymphatic system and has a more potent anti-tumor effect.     

Ultrasound for controlled delivery of therapeutics

Release of substances from polymeric drug delivery systems can be repeatedly modulated at will through ultrasound. Nondegradable-diffusion controlled and degradable-erosion controlled polymeric delivery systems have both been shown to have enhanced kinetics of release when exposed to ultrasonic energy. The effect of ultrasound was also evaluated on skin and synthetic membranes permeability. The main factors contributing to this effect included mixing, temperature, cavitation, acoustic streaming and polymer morphological changes. These phenomena have appealing therapeutic and commercial possibilities, as many drugs may benefit from subtle delivery pattern under temporal control to obtain optimal therapeutic effects.