肝动脉化疗栓塞联合高强度聚焦超声治疗肝癌疗效分析

目的：初步评价肝动脉化疗栓塞（TACE）联合高强度聚焦超声（HIFU）治疗肝癌（HCC）的疗效及安全性。方法：应用TACE联合HIEU（治疗组）和TACE单一治疗原发性肝癌对比观察。结果：联合治疗组在多发性肝癌及大肝癌治疗中有效率、复发率、AFP、肿瘤缩小、生存率、生存时间等存在明显统计学差异。结论：TACE＋HIFU对治疗肝癌是可行有效的，尤其对晚期多发、巨块型肝癌，具有较好临床应用价值。     

高强度聚焦超声治疗肝左叶癌的临床研究

目的 通过高强度聚焦超声（HIFU）治疗原发性肝左叶癌的疗效分析，探讨HIFU治疗原发性肝癌价值。 方法 2001年9月至2003年9月26例原发性肝左叶癌患者接受HIFU治疗，其中21例HIFU治疗前曾行经皮肝动脉栓塞化疗（TACE）治疗，5例行单独的HIFU治疗。所有患者HIFU治疗前后均行血AFP测定。HIFU治疗前后均行超声、CT或MRI检查。 结果 HIFU治疗后血清AFP呈不同程度的下降，其分布有显著统计学意义。HIFU治疗后肿物回声有不同程度增强。HIFU治疗后CT／MRI呈典型的凝固性坏死表现。其中完全缓解（CR）3例，缓解（PR）12例，CR＋PR占57．7％。TACE联合HIFU组近期疗效较单纯HIFU治疗组疗效为好，两组有效率有较为显著的统计学差异。 结论 HIFU治疗肝左叶癌具有一定疗效。HIFU联合TACE治疗肝左叶癌具有协同作用。超声可作为HIFU治疗实时监测工具。     

肝动脉栓塞化疗联合高能量超声聚焦刀治疗肝癌合并门静脉癌栓病人的护理

[目的]探讨肝动脉栓塞化疗联合高能量超声聚焦刀治疗肝癌合并门静脉癌栓病人的护理方法和要点。[方法]对11例肝癌合并门静脉癌栓病人进行肝动脉栓塞化疗并于术后1周内在全身麻醉、心电监护下行高能量超声聚焦刀治疗,在治疗前、中、后对11例病人进行相应的护理。[结果]11例病人均顺利完成治疗,2例病人上腹部疼痛,2例病人恶心、呕吐,1例病人发热,给予对症处理后缓解;2例病人治疗区皮肤肿胀、疼痛,经处理后症状缓解;1例病人术中出现血红蛋白尿,予对症处理后治愈。[结论]肝动脉栓塞化疗联合高能量超声聚焦刀治疗肝癌合并门静脉癌栓,护理中强调治疗前应做好心理护理,严格皮肤准备及胃肠道准备,治疗过程中做好术中配合、治疗区皮肤护理、脱气水水温的监测以及体位固定,治疗后严密监测生命体征、肝肾功能。     

高强度聚焦超声治疗肝细胞型肝癌的现状与进展

高强度聚焦超声(HIFU)作为一种非侵入性治疗手段,能安全、准确、有效地消融肿瘤组织,且不会对周围正常组织造成损伤,其越来越广泛地应用于肝细胞型肝癌(HCC)的临床治疗。目前HIFU治疗主要应用其热效应,二维超声和MRI是常用的监控手段。HIFU联合肝动脉化疗栓塞术能有效提高HCC的治疗效率、安全性及疗效,放疗和超声微泡的应用也可进一步提高治疗效果。本文就HIFU对HCC的现状及进展做一综述。     

高强度聚焦超声治疗未"开窗"肝右叶肝癌的初步研究

目的探讨高强度聚焦超声治疗未"开窗"肝右叶肝癌的临床疗效.方法利用HIFU技术治疗未"开窗"的肝右叶肝癌76例.比较患者HIFU治疗前后临床症状,实验室检查及影像学检查结果.结果 76例患者临床症状较术前有明显改善,AFP较术前明显降低(P=0.005).CT、MRI复查肿瘤全部坏死的有21例(27.6%),坏死区大于75%的有19例(25%),坏死区大于50%的有14例(18.4%),坏死区介于30%～50%之间的22例(28.9%).仅少数患者出现轻度烧伤,未观察到严重并发症发生.结论HIFU作为一种新的肝癌局部治疗手段治疗未"开窗"的肝右叶肝癌同样可取得令人满意的疗效.     

高强度超声聚焦刀联合鸦胆子油乳介入治疗中晚期肝癌35例临床观察

目的探讨高强度超声聚焦刀（HIFU）联合鸦胆子油乳肝动脉化疗栓塞（TACE）治疗中晚期肝癌的临床疗效及安全性。方法采用HIFU联合鸦胆子油乳TACE治疗原发性肝癌18例,转移性肝癌13例,复发性肝癌4例,并通过患者症状体征、血清甲胎蛋白（AFP）水平、彩色多普勒超声或CT及MRI等指标,观察治疗效果及临床安全性。结果35例患者治疗后症状、体征减轻,生活质量明显改善,部分血清AFP水平下降,超声图像变化以肿块内部回声增强为主,瘤周清晰,病变与正常肝组织面积比在治疗前后分别为（23．7±4．1）％和（46．5±5．8）％,差异有统计学意义（P〈0．01）。半年生存率86．7％,治疗期间无并发症。结论HIFU联合鸦胆子油乳TACE是治疗中晚期肝癌的有效治疗手段,具有推广价值。     

高强度聚焦超声联合碘油栓塞损伤肝脏的病理转归及肝、肾功能的变化

目的探讨肝脏局部碘油栓塞联合高强度聚焦超声(HIFU)热切除术后,坏死组织的病理转归及肝、肾功能的变化,阐明联合治疗的安全性。方法10只山羊,肝左叶动脉碘油栓塞和局部HIFU热切除后,分为A、B二组,各5只。A组动物定期观察坏死组织的动态病理变化,而B组则动态观察术后的肝、肾功能变化。结果肝脏碘油栓塞和HIFU治疗后可形成明显的凝固性坏死灶并引起肝、肾功能的明显变化。但随着时间延长,坏死灶逐渐溶解吸收、纤维化,肝肾功能也逐渐恢复正常。结论局部肝脏碘油栓塞联合高强度聚焦超声热切除术是安全的。     

高强度聚焦超声治疗“困难部位”肝癌的安全性及有效性

肝癌是常见的恶性肿瘤,高强度聚焦超声是治疗肝癌的一大安全、有效手段,但其在对肋骨后方及邻近大血管、胆囊和肝外胆管、胃肠的肝癌结节的治疗中消融率较低,治疗难度较大,容易伤及毗邻的重要组织结构。本文就HIFU在治疗"困难部位"肝癌病灶中所遇到的问题,以及如何提高治疗的安全性及有效性做一综述。     

经皮经肝动脉分支穿刺栓塞化疗联合高强度聚焦超声治疗肝癌的疗效评价

目的 探讨经皮经肝动脉分支穿刺栓塞化疗（TAE）联合高强度聚集超声（HIFU）治疗肝癌的疗效。方法 随机选择肝癌10例，其中原发肝癌6例，转移癌4例，于肝动脉栓塞化疗后行HIFU治疗，治疗前后行MRI平扫及增强扫描以评价疗效。结果10例肝癌患者经TAE联合HIFU治疗2周后，MRI显示肿瘤区完全无强化，肿瘤血供阻断呈凝固性坏死者8例；2例肿瘤区周边少许强化，联合HIFU治疗后肿瘤完全无强化，肿瘤血供完全阻断。一个月后复查肿瘤缩小1／3者5例，完全坏死液化者2例，稳定无明显缩小者3例，未见肿瘤增大或扩散转移，其中1例手术切除病理证实癌细胞全部坏死。结论 TAE联合HIFU治疗肝癌能有效切断肿瘤供血和侧支循环的建立，使肿瘤凝固性坏死，两方法联合应用有协同加强杀灭癌细胞作用，是微创、安全，有望达到介入性根治目的的治疗方法。     

声通道上的肋骨对高强度聚焦超声在羊肝内形成凝固性坏死的影响

目的从有效性、安全性和剂量学的角度探讨声通道上的肋骨对高强度聚焦超声（HIFU）损伤山羊肝的影响。方法HIFU分别辐照声通道上有肋骨（对照组）和声通道上肋骨被手术切除（实验组）的羊肝。辐照结束后2d处死动物，观察靶区凝固性坏死形成情况，测量凝固性坏死的体积并计算能效因子（energy efficiency factor，EEF）。结果实验组的凝固性坏死形成率明显高于对照组，EEF远远小于对照组。结论声通道上的肋骨明显影响凝固性坏死的形成率和EEF，提高HIFU治疗受肋骨阻挡的肝癌的治疗效率非常重要。     

Follow-up of high-intensity focused ultrasound treatment for patients with hepatocellular carcinoma

Nonsurgical therapies have become treatment options for hepatocellular carcinoma (HCC). This study was to evaluate the efficacy and complications of high-intensity focused ultrasound (HIFU) treatment for patients with HCC. Between May 2001 and May 2005, 145 patients with HCC were enrolled for treatments using a HIFU tumor therapeutic system. Clinical symptoms, hepatic functions and values of serum α-fetoprotein (AFP) were tested before and after HIFU treatment. The changes in computerized tomography (CT) and magnetic resonance imaging (MRI), complications and survival time after HIFU were also obtained for further analysis. Symptoms improved or pain was relieved in 84.8% of the 145 patients and the rate of serum AFP decrease was 71.7%. The size of the target tumor shrank by various degrees. The 2-year survival rate was 80% in patients with stage Ib HCC, 51.4% in stage IIa and 46.5% in stage IIIa. During HIFU treatment, complications included body temperature increase and abnormal cardiac rhythm. After HIFU procedures, there were skin burns of different grades. In conclusion, HIFU is safe and effective for patients with hepatocellular carcinoma; HIFU can improve the survival quality of patients with HCC.     

Feasibility of High-Intensity Focused Ultrasound for Hepatocellular Carcinoma after Stereotactic Body Radiation Therapy: Initial Experience

The purpose of this initial clinical observation was to investigate the safety and effect of high-intensity focused ultrasound (HIFU) for patients with hepatocellular carcinoma (HCC) after stereotactic body radiation therapy (SBRT). Twenty patients who had been treated with SBRT, with 24 local residuals, received HIFU ablation. The changes of periphery blood cell count and serum biochemistry were observed before HIFU and 1 week after. Contrast-enhanced magnetic resonance imaging before HIFU and 2 weeks after was performed to assess the effect of HIFU. All patients received follow-up. The mean ± standard deviation follow-up time was 19.3 ± 18.0 mo. The median survival time and 1-y survival rate were 21 mo and 76.2%. Seventeen residual lesions (70.8%) received complete ablation and seven received partial ablation, with a mean ablation ratio of 75.8% ± 18.2%. No significant differences were found in periphery blood cell counts or serum biochemistry 1 week after HIFU compared with before HIFU. No severe adverse reactions related to HIFU were observed. Thus, we believe that HIFU can safely and effectively ablate residual HCC after SBRT, which may be a feasible option for patients with HCC who have local residuals after SBRT.     

Treatment of small hepatocellular carcinomas with US-guided high-intensity focused ultrasound

High-intensity focused ultrasound (HIFU) is a noninvasive method that can cause complete coagulation necrosis without requiring the insertion of any instruments. The purpose of this study was to evaluate the safety and efficacy of HIFU treatment for small liver cancers without performing transcatheter arterial chemoembolization (TACE) or rib resection. HIFU ablation was performed without rib resection or the aid of TACE or percutaneous ethanol injection (PEI) in 12 patients with hepatocelullar carcinoma. The HIFU system (Chongqing Haifu Tech, Chongqing, China) was used under ultrasound guidance. All 12 patients completed the treatment without experiencing any adverse events. Complete coagulation was achieved by applying the sonications from the intercostal space when the tumor was located in the right lobe. After treatment, serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) levels were significantly higher than the baseline values; these levels recovered within 1 week. C-reactive protein (CRP) levels increased 1 week after treatment but decreased within 1 month. An epidural anesthetic provided sufficient pain suppression during the procedure. Edema of the subcutaneous tissue was detected in five cases, but the edema disappeared within 1 month. None of the patients developed acute hepatic failure, liver abscess or renal dysfunction. In conclusion, HIFU is effective for the treatment of patients with small liver cancer.     

超声造影对肝动脉栓塞化疗与高强度聚焦超声联合治疗原发性肝癌的临床疗效评价

目的探讨超声造影对动脉栓塞化疗(TACE)与高强度聚焦超声(HIFU)联合治疗原发性肝癌的临床疗效评价。方法经TACE与HIFU联合治疗原发性肝癌(联合组)患者22例,经单纯TACE组54例,单纯HIFU治疗组41例。经TACE与HIFU联合治疗前及治疗后1周进行超声造影检查,观察肿瘤组织内部有无残留血供和遗漏病灶,并对经TACE治疗1~3次未完全灭活的病灶行HIFU补充治疗。结果 TACE组和HIFU组肿瘤灭活率均低于联合组,肿瘤残存率均高于联合组(P0.05);联合组6个月、1年、2年生存率分别为100%、90.9%、81.8%,高于TACE组和HIFU组(P0.05)。结论超声造影对TACE与HIFU联合治疗原发性肝癌的临床疗效能够做出准确判断,显示经TACE与HIFU联合治疗肝癌的疗效明显优于单纯TACE或HIFU治疗。     

HIFU治疗原发性肝癌的CT表现及价值

目的：探讨HIFU治疗原发性肝癌的CT表现及价值。方法：18例原发性肝癌患者HIFU治疗后行CT检查,对比治疗前后CT改变。5例治疗后行病灶切除,观察其病理组织学改变,并与CT表现对照。结果：治疗后12例（12／18,66．7％）病灶体积缩小。16例（16／18,88．9％）病灶密度降低,强化程度减弱,2例病灶内及周边有小片轻度增强。组织病理学检查发现HIFU治疗区内肿瘤组织出现凝固性坏死,病理结果与CT表现一致。结论：CT可以反映HIFU后瘤体的组织学及血供变化,对评价HIFU治疗原发性肝癌的效果及预后具有重要价值。     

平阳霉素碘油乳剂治疗症状性子宫肌瘤

目的：探讨平阳霉素碘油乳剂（Pinyangmycin Lipiodol Emulsion PLE)治疗症状性子宫肌瘤的疗效及临床应用。材料与方法：17例患者术前明确诊断为子宫肌瘤,采用Seldinger技术行双侧子宫动脉超选择插管注入PLE;17例行25次动脉栓塞,其中8例分别做了2次栓塞治疗。结果：全部病例均为双侧子宫动脉供血并行靶血管栓塞,术后随访3－9个月,瘤体平均缩小44％,有效率100％,2例患者术后4月B超复查瘤体基本消失,10例术后1月后月经恢复正常,3例绝经期年龄患者术后2月闭经,2例患者术后2月贫血及压迫症状明显改善。结论：PLE治疗症状性子宫肌瘤近期疗效显著,副作用轻,安全性好,是一种理想的治疗方法。     

TOCE联合HIFU治疗原发性肝癌疗效的CT评价

目的用CT评价TOCE联合HIFU治疗原发性肝癌的疗效。方法46例接受TOCE联合HIFU治疗的原发性肝癌为研究组,比较治疗前后的CT表现;随机选出同期46例单纯TOCE治疗的患者为对照组,进行对比分析。结果研究组37例(37/46,80.4％)病灶体积缩小,缩小率为(27.25±19.89)％;对照组28例(28/46,61.8％)病灶体积缩小,缩小率为(11.89±15.96)％。研究组栓塞灶周边复发5例,对照组15例。研究组肝内转移灶15例,对照组16例。在已栓塞灶瘤体大小变化及局部复发方面,前者优于后者,在肝内转移方面无明显差异。结论TOCE联合HIFU是治疗原发性肝癌的一种有效方法,CT在其疗效及预后判断中具有重要价值。     

The use of a segmented transducer for rib sparing in HIFU treatments

The use of focused ultrasound as a minimally invasive treatment for tumours is rapidly expanding. Target organs include the liver and kidneys. Both single element and phased array transducers may be used in the clinic. The presence of the rib cage presents a problem in high intensity focused ultrasound (HIFU) treatment planning, due to its high attenuation of the HIFU beam resulting in a loss of power at the focus as well as an increase in the risk of damage at the rib and to overlying tissues, including the skin. In this paper, a linearly segmented transducer, in which all active elements are driven in phase, has been investigated. The aim of the study was to investigate how a beam with a clinically useful profile could be achieved by removing the contribution of edge segments from one side of the transducer to the field. We have considered the case in which the HIFU beam approaches the rib cage during a treatment and investigated configurations of the transducer for which up to three segments on the edge are switched off. This problem has been studied initially using a linear acoustic field program to model the segmented transducer's acoustic beam profile. Experimental measurements of the transducer's acoustic field were performed using an automated beam plotting system. Temperature measurements were made on a rib surface for two transducer configurations using a fine wire thermocouple. A thermochromic liquid crystal material was used to assess qualitatively the heating pattern generated by the ultrasound beam. We show the rib sparing potential of the segmented transducer during HIFU treatment by demonstrating a reduction in the prefocal width of the ultrasound beam when edge segments are switched off. This has been predicted with the acoustic field model and demonstrated experimentally by acoustic field measurements and observations of the heating pattern generated by the ultrasound beam. A significant decrease in the temperature rise on a rib was observed in the case for which three edge segments were switched off compared with when all segments were active. We conclude that a segmented transducer extends the potential for treating liver tumours. In the case where the tumour lies behind, but close to the edge of, the ribs, energy loss at the focus and excessive heating in the rib and overlying tissue can be avoided by switching off edge segments.