高强度超声聚焦刀治疗晚期胰腺癌疼痛

目的：探讨高强度超声聚焦刀对于晚期胰腺癌疼痛治疗的价值。方法：应用超声聚焦刀治疗晚期胰腺癌37例，用11点数字评分法（NRS-11）评价比较治疗前后患者的疼痛情况。结果：治疗后患者的NRS-11明显较治疗前降低（P〈0．05）。结论：超声聚焦刀对晚期胰腺癌患者，在改善生活质量、缓解疼痛方面作用显著。     

HIFU姑息性治疗不能手术的晚期胰腺癌的疗效分析

目的研究高强度聚焦超声对不能手术的晚期胰腺癌止痛的疗效和并发症发生情况。方法采用HIFU治疗25例不能手术的晚期胰腺癌患者,观察疼痛变化和并发症情况,了解HIFU的近期治疗效果。结果25例不能手术的晚期胰腺癌患者经HIFU治疗后,88％的患者疼痛不同程度减轻,无上消化道出血或胃肠穿孔等严重并发症,增强MRI显示HIFU治疗区内组织消融。结论HIFU是安全、有效的,可以对不能手术的晚期胰腺癌患者进行姑息治疗方法。     

高强度聚焦超声治疗晚期胰腺癌疼痛疗效分析

 目的 探讨高强度聚焦超声治疗晚期胰腺癌疼痛的疗效和安全性.方法 对22例晚期胰腺癌行高强度聚焦超声治疗,观察治疗前后的疼痛评分、生活质量评分变化及不良反应.结果 全组疼痛缓解总有效率为85％,其中完全缓解10.00％ (2/20),部分缓解55.00％ (11/20),轻微缓解25.00％ (5/20),无效10.00％(2/20).未发生严重并发症.结论 高强度聚焦超声是一种治疗晚期胰腺癌疼痛的有效方法,具有无创和较高的安全性.     

超声介导腹腔神经节去除治疗胰腺癌疼痛的护理

目的探讨超声介导腹腔神经节去除对胰腺癌疼痛患者的治疗作用及护理要点。方法采用B超定位，实时超声动态监测经皮穿刺，于腹腔动脉干根部旁侧注入无水乙醇15ml，对114例胰腺癌疼痛患者实施腹腔神经节去除术。对比观察治疗前后疼痛的视觉模拟评分（VAS）、血清SP水平变化，并对穿刺治疗过程进行严密的护理观察。结果114例中仅1例失败，成功率99．0％，无急性胰腺炎、胰瘘及出血等穿刺并发症；VAS及血清sp较术前明显降低（P〈0．01，P〈0．05）；总有效率88．4％，显效率75．2％，13例无效。结论本微创技术具有很高的安全性，能显著减轻胰腺癌疼痛并提高患者的生存质量。     

高强度聚焦超声治疗晚期胰腺癌疼痛20例

目前,癌性疼痛的治疗仍然以药物为主。单一药物止痛用药量大,用药频繁,不良反应多。笔者对42例晚期胰腺癌疼痛患者,分别行单纯药物镇痛和高强度聚焦超声（High intensity focused ultrasound,HIFU）加药物治疗,后者用药量显著减少,药物依赖性产生的时间明显延长,为癌性疼痛镇痛治疗探索出一种新方法。     

晚期胰腺癌放射治疗辅助热疗的近期疗效分析

晚期胰腺癌的手术切除率低，放疗和化疗均不敏感。高能聚焦超声（HIFU）是一种无创性治疗技术，以超声为能源，在体外对肿瘤聚焦，通过焦点的超声产生高温等效应杀死肿瘤。为探讨HIFU用于胰腺癌治疗的有效性和配合放疗的可行性进行临床分析。     

三维适形放疗联合吉西他滨治疗胰腺癌疗效观察

目的：观察三维适形放疗联合吉西他滨治疗局部晚期胰腺癌的疗效。方法：局部晚期胰腺癌42例随机分为观察组和对照组各21例。观察组采用三维适形放疗,同时给予吉西他滨同步化疗,放疗开始的第1、8、29、36天,给予吉西他滨1000mg／群;对照组采用单纯放疗。结果：两组总有效率、1年生存率比较,差异不显著（P〉0．05）;2年生存率及中位生存期比较,差异显著（P〈0．05）;观察组CBR指数优于对照组;两组疼痛评分比较,差异显著（P〈0．05）;观察组KPS评分升高、体重增加等与对照组比较,差异不显著（P〉0．05）。结论：三维适型放疗联合吉西他滨治疗局部晚期胰腺癌,能控制肿瘤生长,缓解疼痛,改善患者生活质量,延长生存期。     

B超引导经皮腹腔神经节毁损治疗胰腺癌疼痛的临床应用

目的：探讨B超引导经皮腹腔神经节毁损对胰腺癌疼痛患者的治疗作用及护理特点。方法：108例胰腺癌疼痛患者采取B超引导经皮穿刺，于腹腔动脉干根部旁侧注入无水乙醇15ml，实施腹腔神经节化学性毁损。对比观察治疗前后疼痛的视觉模拟评分（VAS）、血清SP水平变化，并对穿刺治疗过程进行严密的护理观察。结果：108例中仅1例失败，成功率99．o％，无急性胰腺炎、胰瘘及出血等穿刺并发症；VAS及血清sp较术前明显降低（P〈0．01，〈O．05）。总有效率87．8％，显效率75．7％，13例无效。结论：B超引导经皮腹腔神经节毁损术安全可靠，能显著减轻胰腺癌疼痛并提高患者的生存质量。     

晚期肝癌介入栓塞化疗加射频热疗的疗效评价

目的：研究晚期肝癌介入栓塞化疗（TACE）加射频热疗的疗效和毒副作用。方法：原发性或转移性肝癌33例，分为两组，TACE加热疗组14例，单纯TACE组19例。所有患者均介入肝动脉灌注化疗药物并栓塞，TACE加热疗组于介入栓塞后行上腹部射频热疗，治疗3周期后，以WHO疗效评价标准评价疗效。治疗前后进行肝功能分级，骨髓毒副作用参照WHO化疗毒副作用标准评价，以χ^2检验法比较组间差异。结果：TACE加热疗组，3例部分缓解（PR）（21．4％），5例病灶稳定（SD）（35．7％）；单纯介入栓塞组有2例PR（10．5％），3例SD（15．8G）；疾病控制率（PR＋CR＋SD）分别为51．7％及26．3％（P〈0．05）；两组间肝功能，血常规变化未见明显差异（P〉0．05）。结论：本研究提示TACE加射频热疗较单纯介入栓塞治疗临床有效率高，副作用未见明显差异。     

HIFU联合吉西他滨＋顺铂对晚期胰腺癌疗效观察

目的 观察高强度聚焦超声(HIFU)联合吉西他滨+顺铂方案治疗晚期胰腺癌的疗效. 方法 56例晚期胰腺癌患者随机分为两组:A组为HIFU联合吉西他滨+顺铂方案化疗组;B组为单纯吉西他滨+顺铂方案化疗组. 结果 A组有效率36.7%,B组34.6%,两组比较无显著性差异(P＞0.05);A组临床受益率66.7%,B组38.5%,两组比较差异有显著性(P＜0.05). 结论 HIFU联合吉西他滨+顺铂方案治疗晚期胰腺癌有更好的疗效.     

DWI应用于兔VX2肝癌模型HIFU治疗的价值

目的研究兔VX2肝癌模型在高强度聚焦超声(HIFU)治疗前后肿瘤扩散的变化。材料与方法 45只兔VX2肝癌模型HIFU治疗前及HIFU治疗后1、3、7、14、21天5个观测点进行磁共振扩散加权成像(DWI),观察术后5个观测点肿瘤与术前表观扩散系数(ADC)值的变化,并与病理结果对照分析。结果兔VX2肝癌模型HIFU术后1、3、7、14、21天,ADC图上呈高信号的肿瘤病理为坏死组织,ADC值较术前相应区域升高(P<0.05);术后3、7、14、21天,ADC图上呈混杂信号的肿瘤,高信号区病理为坏死组织,ADC值较术前相应区域升高(P<0.05);而低信号区病理为肿瘤组织,ADC值较术前相应区域无差异性(P>0.05)。结论磁共振DWI ADC值能够准确反映兔VX2肝癌模型HIFU治疗后的肿瘤坏死组织及存活组织,并能够作为HIFU治疗兔VX2肝癌疗效的重要监测手段。     

Dynamic contrast-enhanced MR evaluation of prostate cancer before and after endorectal high-intensity focused ultrasound

Purpose

The authors sought to determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging in the evaluation of prostate cancer before and after transrectal high-intensity focused ultrasound (HIFU) treatment.

Materials and methods

We analysed 25 patients with prostate cancer. The prostate-specific antigen (PSA) value was evaluated 1, 4 and 6 months after treatment. DCE-MR imaging was performed the day prior to and 1, 4 and 6 months after HIFU treatment. Transrectal prostate biopsies were obtained at the time of diagnosis and 6 months after treatment.

Results

Before treatment, intraglandular lesions were considered to be potential sites of neoplasm and subsequently confirmed as sites of prostate adenocarcinoma in all 25 patients based on prostatespecific antigen (PSA) values and histological examinations (rho=1; p<0.001). Using histology as the gold standard, DCE-MR imaging displayed 100% sensitivity, 100% specificity, 100% positive predictive value and 100% negative predictive value before treatment. After HIFU treatment, DCE-MR imaging showed 100% sensitivity and 96% specificity.

Conclusions

DCE-MR imaging can be used to visualise prostate adenocarcinoma. Several morphological and postgadolinium modifications in the follow-up DCE-MR images after HIFU treatment were also observed.     

MRI对TAE联合HIFU治疗肝癌的评价

目的探讨TAE联合高强度超声聚焦刀(HIFU)治疗肝癌的疗效及MRI对其的评价。方法随机选择肝癌20例,其中原发肝癌12例,转移癌8例,行肝动脉栓塞化疗后行HIFU治疗,治疗前后MRI平扫及增强扫描了解疗效。结果TAE联合HIFU治疗2周后,16例MRI显示肿瘤区完全无强化,肿瘤血供阻断呈凝固性坏死;4例肿瘤区周边少许血供强化,追加HIFU治疗后肿瘤完全无强化,肿瘤血供完全阻断。1个月后复查肿瘤缩小1/3者10例,完全坏死液化4例,稳定无明显缩小6例,未见肿瘤增大或扩散转移。结论TAE联合HIFU治疗肝癌是一种微创、安全的,有望达到介入性根治目的的治疗方法。     

彩色多普勒超声对高强度聚焦超声治疗子宫肌瘤、腺肌瘤的疗效评价

目的:探讨彩色多普勒血流显像(color Doppler flow imaging,CDFI)对高强度聚焦超声(high intensity focused ultra-sound,HIFU)治疗子宫(腺)肌瘤的近期疗效及其实用性。方法:对经临床及阴道超声确诊子宫(腺)肌瘤的136例患者行HIFU治疗,应用CDFI观察比较治疗前后瘤体大小、回声、血流动力学等不同的改变。结果:136例子宫(腺)肌瘤HIFU治疗后1~6个月CDFI随访统计,瘤体明显缩小者86例,瘤体内回声明显增强改变113例,血流信号消失或明显明显减少者110例,月经期经量明显减少,临床症状明显改善者105例。HIFU治疗子宫(腺)肌瘤总有效率为83.09%(113/136)。结论:彩色多普勒超声能较好地观察子宫肌瘤HIFU治疗前后瘤体的回声、血供和体积大小的改变,是HIFU术后随访及疗效评价的有效手段之一。     

Whole-Body Bone Scan Findings after High-Intensity Focused Ultrasound (HIFU) Treatment

Purpose

This study aims to examine the findings of ^99mTc-diphosphonate bone scans in cancer patients with a history of HIFU treatment.

Methods

Bone scan images of patients with a history of HIFU treatment for primary or metastatic cancer from January 2006 to July 2010 were retrospectively reviewed. Cases of primary bone tumor or HIFU treatment reaching only the superficial soft tissue layer were excluded.

Results

Bone scan images of 62 patients (26 female, 36 male; mean age 57 ± 9 years) were studied. HIFU treatment was performed in the liver (n = 40), pancreas (n = 16), and breast (n = 6). Mean interval time between HIFU treatment and bone scan was 106 ± 105 days (range: 1–572 days). Of 62 scans, 43 showed diffusely decreased uptake of bone within the path of HIFU treatment: antero-axillary and/or posterior arcs of right 5th to 11th ribs in 34 cases after treatment of hepatic lesions; anterior arcs of 2nd to 5th ribs in 5 cases after treatment for breast tumors; and posterior arcs of left 9th to 11th ribs or thoraco-lumbar vertebrae in 4 cases after treatment for pancreas tumor. Of 20 patients who had bone scans more than twice, five showed recovered uptake of the radiotracer in the involved ribs in the follow-up bone scan.

Conclusion

Of 62 bone scans in patients with a history of HIFU treatment for primary or metastatic cancer, 69% presented diffusely decreased uptake in the bone in the path of HIFU treatment.     

CT导向下腹腔神经丛阻滞治疗晚期癌症所致上腹部顽固性疼痛的临床应用

目的　探讨腹腔神经丛阻滞治疗晚期癌症所致上腹部顽固性疼痛的应用价值。方法　 2 4例由胰腺癌、胃癌、结肠癌、肝癌、直肠癌和胆囊癌伴转移引起的上腹部顽固性疼痛的患者 ,在CT导引下实施了双侧腹腔神经丛酒精阻滞。结果　治疗 1月后 ,6例患者疼痛消失 ,其余 18例疼痛较治疗前有好转。本组无 1例有严重并发症。结论　CT导引下腹腔神经丛阻滞对晚期癌症所致上腹部顽固性疼痛是一种有效的方法     

高强度聚焦超声治疗瘢痕妊娠对卵巢储备功能的影响

 目的 比较高强度聚焦超声(high intensity focused ultrasound, HIFU)和子宫动脉栓塞术(uterine artery embolization, UAE)治疗剖宫产瘢痕妊娠(cesarean scar pregnancy, CSP)时对卵巢储备功能的影响。方法 采用回顾性研究的方法,选择2013-01至2018-06保定市妇幼保健院收治的CSPⅡ型患者142例,根据治疗前预处理方法不同分为两组,HIFU组96例采用HIFU,UAE组46例采用UAE,预处理后行宫腹腔镜手术,比较两组术前,术后3、6、12个月的血清雌二醇(E₂)、卵泡刺激素(FSH)、促黄体生成素(LH)、抗苗勒管激素(AMH)水平及窦卵泡数(AFC)的变化。比较两组术后患者血HCG在4周内转阴率及5周内月经恢复率。结果 (1)HIFU组不同时间点AMH、FSH、LH、E₂和AFC比较,差异均无统计学意义。(2)UAE组不同时间点E₂差异无统计学意义;而AMH、AFC在UAE后3、6、12个月较术前显著降低;FSH及LH在术后 3、6个月较前明显升高,差异均有统计学意义(P<0.05)。(3)两组相比,术前AMH、FSH、LH、E₂、AFC差异均无统计学意义;UAE组AMH、AFC术后3个月、6个月均低于HIFU组相应时间点,而FSH、LH水平则高于HIFU组,差异均有统计学意义(P<0.05)。(4)HIFU组和UAE组术后5周月经恢复率分别为98.9%和91.3%,两组差异有统计学意义(P<0.05);两组术后4周血β-HCG转阴率比较,差异无统计学意义。结论 HIFU治疗CSP安全有效、无创、可重复,不影响卵巢储备功能,尤其对于有再生育要求的CSP患者更具有重要意义。     

Evaluation of short-term response of high intensity focused ultrasound ablation for primary hepatic carcinoma: Utility of contrast-enhanced MRI and diffusion-weighted imaging

Objective

To explore the significance of contrast-enhanced MRI (CE-MRI) and diffusion-weighted imaging (DWI) in evaluating the short-term response of high intensity focused ultrasound (HIFU) ablation for primary hepatic carcinoma (PHC).

Methods

Thirty-nine lesions in the livers of 27 patients were performed HIFU ablation. Conventional MRI sequences, CE-MRI and DWI were performed 1 week before HIFU and 1 week, 3 months after the therapy, respectively. The short-term responses of HIFU for all lesions were evaluated with MRI.

Results

28 of the 39 lesions (28/39, 71.8%) showed complete necrosis with no enhancement 1 week and 3 months after HIFU. The apparent diffusion coefficient (ADC) values 1 week and 3 months after HIFU were significantly higher than those 1 week before treatment (p < 0.05). The tumor recurrence was detected in 7 of the 39 lesions (7/39, 17.9%) which had no significant enhancement 1 week after HIFU. On the 3 months follow-up, focal nodules were found on the inner aspects of the treated areas. The ADC values had no significant difference between 1 week before and after treatment (p > 0.05), however, they were significantly higher 3 months after HIFU (p < 0.05). The tumor residuals were detected in 4 of the 39 lesions (4/39, 10.3%) showing enhancement 1 week after treatment and increased size 3 months after HIFU. The ADC values had no significant difference among 1 week before HIFU, 1 week and 3 months after treatment (p > 0.05).

Conclusion

CE-MRI and DWI can be employed to evaluate the short-term response of HIFU ablation for PHC and to guide the patient management.     

高强度聚焦超声治疗子宫肌瘤的疗效分析

 目的 探讨高强度聚焦超声(high intensity focused ultrasound, HIFU)治疗子宫肌瘤的临床疗效及安全性。方法 2014-03至2015-06采用HIFU治疗子宫肌瘤患者88例,观察并分析患者术中术后反应、临床症状缓解情况及影像学改变情况。结果 治疗中无神经损伤、膀胱损伤、肠穿孔、皮肤烧伤等严重并发症发生; 35例月经量增多患者治疗后1、3、6个月后月经量减少至原月经量的百分数分别为(71±11)%、(55±10)%、(49±11)%;21例继发性贫血患者治疗前Hb水平为(92±8)g/L、治疗后6个月血红蛋白水平为(121±13) g/L,差异有统计学意义(t=8.71,P<0.05)。24例痛经患者治疗前痛经NPIS评分为(7.8±1.1),治疗后6个月痛经NPIS评分为(2.3±0.8),差异有统计学意义(t=19.81,P<0.05)。治疗后1、3、6个月超声检查显示子宫肌瘤体积缩小率为(33.23±14.03) %、(48.42±14.56) %、(63.76±18.05)%。6个月后超声检查CDFI显示所有患者肌瘤内血流信号明显减少或消失,与治疗前比较,差异有统计学意义(Zc=9.63,P<0.05)。结论 HIFU治疗子宫肌瘤近期疗效显著,能有效减轻临床症状,是治疗子宫肌瘤的安全、有效、无创的新方法。     

子宫瘢痕妊娠清宫术前高强度聚焦超声和子宫动脉栓塞的比较

 目的 比较子宫瘢痕妊娠(cesarean scar pregnancy,CSP) 清宫术前高强度超声聚焦(high intensity focused ultrasound,HIFU)与子宫动脉栓塞(uterine artery embolization, UAE)的差异。方法 回顾性分析2013-01至2018-10武警特色医学中心妇产科收治的77例CSP病例资料,根据清宫术前预处理方法的不同分为两组,海扶组先行高强度超声聚焦治疗,子宫动脉栓塞组先行子宫动脉灌注栓塞治疗,均在治疗后2～3 d再行清宫术。分析孕龄、剖宫产次数、距前次剖宫产时间、妊娠时间、孕囊平均直径、子宫瘢痕处肌层厚度、手术时间、术中出血量、住院时间、住院费用、清宫术时转为开腹手术的例数、手术方式及CSP分型情况等。结果 海扶组术中出血>50 ml的有2例,占5.41%,子宫动脉栓塞组出血>50 ml的有6例,占17.14%,海扶组比例明显低于子宫动脉栓塞组(P＜0.05)。CSPⅢ型的5例患者,其中海扶组有2例,子宫动脉栓塞组有3例,刮宫术时均因出血多转为开腹手术。两组在清宫时间、住院时间和住院费用方面,海扶组明显低于子宫动脉栓塞组,差异有统计学意义(均P＜0.05)。结论 HIFU联合清宫术终止CSP安全、有效。