肋骨切除术在HIFU联合TACE治疗中晚期肝癌中的临床价值

目的:探讨肋骨切除术在高强度聚焦超声(Hihg intensity focused ultrasound,HIFU)联合经导管动脉栓塞化疗(Tran-seatheter arterial chemoembolization,TACE)治疗中晚期肝癌中的临床价值.方法:68例右叶中晚期肝癌分为肋骨切除组(36例,43病灶)和非肋骨切除组(32例,40病灶),随访两组患者HIFU联合TACE后的疗效,并进行比较.结果:总平均随访(11.9±11.4)月,两组中位生存期及1、2年生存率分别依次为13月、52.3%、21.8%与12月、46.8%、17.6%,两组比较无统计学意义(P=0.8155);其病灶完整消融率和消融体积>80%比例分别依次为46.5%、79.1%与37.5%、67.5%,两组比较无统计学意义(P>0.05).结论:肋骨切除术不能有效提高HIFU联合TACE治疗中晚期肝癌的疗效.     

经直肠高强度聚焦超声(HIFU)治疗良性前列腺增生的临床研究

目的探讨经直肠高强度聚焦超声（high-intensity focused ultrasound，HIFU）治疗良性前列腺增生（BPH）的有效性和安全性。方法对150例BPH患者采用Sonablate 500型“经直肠超声聚能刀”进行前列腺消融术。在术前、术后30min，1、2、6和12个月，经直肠超声观察前列腺和前列腺部尿道的影像学变化，通过尿液分析、国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）和残余尿量（PVR）进行疗效评估，同时观察术后并发症。23例术后12个月行排尿期膀胱尿道造影。结果对143例进行了12个月的观察随访，术后IPSS评分和QOL评分降低，PVR减少，Qmax明显提高（P〈0．01），前列腺体积缩小（P〈0．05）。前列腺消融时间25—90min。术后留置尿管时间为3—19d，7例术后反复排尿困难、药物治疗效果不佳者行TURP手术，3例患者出现附睾炎，1例术后15d发生尿道直肠瘘。术后经直肠超声观察和膀胱尿道造影，证实术后前列腺部尿道较术前明显增宽。结论“经直肠超声聚能刀”前列腺消融术，能对前列腺组织进行选择性破坏，具有微创（无血手术）、安全和并发症少等优点。对前列腺中叶增生明显者可联合TURP治疗。“经直肠超声聚能刀”治疗BPH近期疗效满意，远期疗效有待进一步观察。     

高强度聚焦超声联合赛来昔布治疗胰腺癌裸鼠移植瘤的实验研究

目的研究高强度聚焦超声（HIFU）联合选择性环氧合酶-2抑制剂赛来昔布对胰腺癌裸鼠移植瘤生长的影响。方法40只裸鼠建立胰腺癌裸鼠移植瘤模型，随机分对照组、HIFU组、赛来昔布组及联合组共观察40d，研究各处理因素对移植瘤生长的影响。观察4组移植瘤组织病理学变化，RT-PCR检测bcl-2、bax及HSP70的表达，免疫组化检测HSP70的表达。结果联合组移植瘤平均体积最小，赛来昔布组、HIFU组、联合组抑瘤率分别为81．3％、93％、99．7％。病理示HIFU组和联合组中见大片凝固性坏死，HIFU组可见残留癌细胞小岛而联合组未见。FT-PCR示bcl-2在各组中均表达极弱；bax在HIFU组、赛来昔布组及联合组中表达均上调；HSP70以联合组表达上调最明显。免疫组化示HIFU组、联合组HSP70呈强阳性表达。结论HIFU与赛来昔布联合对胰腺癌裸鼠移植瘤的治疗可起到协同作用。HIFU不仅可以直接杀灭肿瘤细胞，而且可以通过上调bax的表达诱导肿瘤细胞凋亡；通过上调HSP70的表达激发机体的免疫反应进一步抑制肿瘤生长。     

High-intensity focused ultrasound for the targeted destruction of uterine tissues: experiences from a pilot study using a mobile HIFU unit

Background High intensity focused ultrasound (HIFU) is a novel method which offers the non-invasive ablation of tissues without harming overlying organs or skin. It has been introduced successfully in urology for the ablation of prostatic hyperplasia and seems to be promising in the treatment of uterine fibroids. In this study we aimed to examine the feasibility and possible side effects of HIFU treatment of uterine tissues using an experimental mobile HIFU unit with ultrasound guidance. Methods For these experiments, a 1.07 MHz ultrasound source was used which allows treatment depths between 0 and 10 cm. In 12 patients scheduled to have abdominal hysterectomy, 5–60 impulses of HIFU were applied through the intact skin upon uterine tissues directly prior to the surgical procedure. Tissue intensities lay between 3,200 and 6,300 W/cm2 and a fixed pulse length of 4 s was used. Results No side effects were encountered other than one first-degree skin burn and the treatment was well tolerated. Histology showed clearly demarcated coagulative necrosis in the targeted tissues. Treatment was concluded in less than 45 min for each patient. Conclusion Focused ultrasound is an effective method to selectively destroy tissue within the uterus and the transabdominal access route is very feasible. This study shows that a mobile ultrasound source can be used safely and effectively to destroy uterine tissues, such as fibroids, without major side effects.     

Feasibility of magnetic resonance imaging-guided high intensity focused ultrasound therapy for ablating uterine fibroids in patients with bowel lies anterior to uterus

Purpose

To prospectively evaluate the feasibility of magnetic resonance (MR) imaging-guided high intensity focused ultrasound (HIFU) therapeutic ablation of uterine fibroids in patients with bowel lies anterior to uterus.

Materials and methods

Twenty-one patients with 23 uterine fibroids underwent MR imaging-guided high intensity focused ultrasound treatment, with a mean age of 39.4 ± 6.9 (20-49) years, with fibroids average measuring 6.0 ± 1.6 (range, 2.9-9.5) cm in diameter. After being compressed with a degassed water balloon on abdominal wall, MR imaging-guided high intensity focused ultrasound treatment was performed under conscious sedation by using fentanyl and midazolam. This procedure was performed by a Haifu^® JM focused ultrasound tumour therapeutic system (JM2.5C, Chongqing Haifu Technology Co., Ltd., China), in combination with a 1.5-Tesla MRI system (Symphony, Siemens, Germany), which provides real-time guidance and control. Contrast-enhanced MR imaging was performed to evaluate the efficacy of thermal ablation immediately and 3 months after HIFU treatment. The treatment time and adverse events were recorded.

Results

The mean fibroid volume was 97.0 ± 78.3 (range, 12.7-318.3) cm³. According to the treatment plan, an average 75.0 ± 11.4% (range, 37.8-92.4%) of the fibroid volume was treated. The mean fibroid volume immediately after HIFU was 109.7 ± 93.1 (range, 11.9-389.6) cm³, slightly enlarged because of edema. The average non-perfused volume was 83.3 ± 71.7 (range, 7.7-282.9) cm³, the average fractional ablation, which was defined as non-perfused volume divided by the fibroid volume immediately after HIFU treatment, was 76.9 ± 18.7% (range, 21.0-97.0%). There were no statistically significant differences between the treatment volume and the non-perfused volume. Follow-up magnetic resonance imaging (MRI) at 3 months obtained in 12 patients, the fibroid volume decreased by 31.4 ± 29.3% (range, −1.9 to 60.0%) in average, with paired t-test showing a statistically significant reduction (P = 0.002). The mean treatment time for ablating the average 83.3 ± 71.7 (range, 7.7-282.9) cm³ of fibroid volume was 2.5 ± 1.4 h (range, 27-390 min) in this study, which was relatively short and acceptable to patient and therapist. Four patients experienced mild skin burn (two with skin redness, two with blisters), the skin burn subsided within ∼2 days. No other adverse events were observed.

Conclusions

After the bowel was compressed with a degassed water balloon, MR imaging-guided high intensity focused ultrasound treatment is safe and feasible in ablating uterine fibroids in patients with bowel lies anterior to uterus.     

相控型HIFU系统软件的开发与应用

介绍采用计算机图形学和数据库的相关技术,在自主研发的多阵元相控聚焦超声治疗设备上开发了一套可视化HIFU系统软件。经实验验证,该系统软件能够有效制定治疗规划,实施实验治疗方案,促进临床实验研究。     

高强度聚焦超声终止小鼠妊娠的实验研究

目的:探讨高强度聚焦超声(H IFU)终止妊娠的可能性。方法:利用H IFU治疗机(780 kHZ)6种声强各60s体内直接照射妊娠第7天小鼠胚胎,妊娠15 d时观察各组胚胎死亡率和胎盘、子宫的形态学变化。结果:对照组胚胎总死亡率为12.65%(32/253);照射组中声强3 W/cm2、6 W/cm2及≥9 W/cm2组的胚胎死亡率分别为25.00%(12/48)、72.88%(43/59)和100%(64/64、43/43、40/40、35/35)。超声照射后8 d的改变:光镜下主要为胎盘出血、变性、坏死;电镜下胎盘组织细胞坏死呈致密团块状,子宫改变轻微。变化随剂量的增加而明显。结论:胎盘较子宫对H IFU更敏感,更易受损,H IFU抗早孕具有潜在的可行性,值得进一步研究。     

Evaluation of color Doppler in guiding prostate biopsy after HIFU ablation

OBJECTIVE: Transrectal ultrasound cannot accurately depict early cancer recurrences after prostate high-intensity focused ultrasound (HIFU) ablation. We evaluated transrectal color Doppler (CD) in guiding post-HIFU prostate biopsy. METHODS: Prostate CD-guided sextant biopsies were obtained in 82 patients who had undergone prostate HIFU ablation for cancer, 24 of whom had hormone therapy before the treatment. At the time of biopsy, a subjective CD score was given to all biopsy sites (0=no flow; 1=minimal flow; 2=suspicious flow pattern). CD findings were compared with biopsy results. RESULTS: CD was a significant predictor of biopsy findings, according to univariate and multivariate site-by-site analysis. However, only 36 of 94 sites with residual cancer had positive CD findings, and thus, negative CD findings should not preclude random biopsy. There was a significant interaction between CD diagnostic capability and a history of hormone therapy before HIFU treatment. CD was a significant and independent predictor of biopsy findings in patients who had not received hormone therapy (odds ratio: 4.4; 95%CI: 2.5-7.9; p<0.0001), but not in those who had (odds ratio: 1.3; 95%CI: 0.5-3.4; p>0.5). CONCLUSION: Biopsy taken in CD-positive sites were 4.4 times more likely to contain cancer in patients who did not receive hormone therapy. CD could not reliably depict cancer recurrence in patients with history of hormone therapy.     

高强度聚焦超声治疗子宫肌瘤和肌腺瘤临床分析

目的:观察高强度聚焦超声治疗子宫肌瘤、肌腺瘤的临床疗效。方法:采用北京源德公司生产的BY-01型高能聚焦肿瘤治疗机对15例子宫肌腺瘤、子宫肌瘤患者进行治疗,于治疗后的1、3、6个月分别进行随访,观察临床症状、瘤体大小、B超图像及病灶血供丰富程度。结果:治疗后3个月时临床症状明显改善,6个月时瘤体开始缩小,平均约1~1.5cm,12个月时缩小平均为3cm;声像图改变为1个月病灶回声稍增强,血流消失,大小无明显改变,3~6个月病灶回声增强,血流消失,瘤体缩小约1~2cm左右。结论:HIFU治疗时无创伤、无副作用,是治疗子宫肌瘤、肌腺瘤的安全、有效方法。