高强度聚焦超声治疗老年中晚期胰腺癌的临床观察

目的评价高强度聚焦超声（highintensityfocusedultrasound，HIFU）治疗老年中晚期胰腺癌的疗效和安全性。方法对189例老年中晚期胰腺癌患者行HIFU治疗，观察治疗前后的影像学变化及临床症状、临床受益率（clinicalbenefitresponserate，CBR）、咀清糖类抗原19—9（carbohydrateantigen19—9，CA19—9）水平及不良反应。结果CBR率67％，HIFU治疗后疼痛明显缓解（P〈0．05），肿瘤体积稳定，CA19—9下降（P〈0．05），朱发生胰腺炎、胃肠道损伤。结论HIFU治疗老年中晚期胰腺癌可明显缓解症状、改善生活质量，提高临床受益率，且无严重毒副反应，是一种治疗胰腺癌的有效方法。     

高强度聚焦超声联合吉西他滨治疗不可切除胰腺癌的临床疗效

目的探讨高强度聚焦超声（HIFU）联合吉西他滨治疗不可切除胰腺癌的疗效和安全性。方法将48例在我院确诊为不可切除胰腺癌患者随机分为HIFU联合吉西他滨组和单纯吉西他滨化疗组。观察治疗后临床受益率、近期有效率、生存率和不良反应。结果联合治疗组和单纯吉西他滨治疗组相比临床受益率（CBR）（83．3％VS30．0％,P〈0．05）、中位生存期（MST）（10．4个月VS6．4个月,P〈0．05）、6和12个月生存率（73．8％,35．2％VS52．3％,17．3％,P〈0．05）差异均具有统计学意义。而疾病控制率（DCR）（82．1％VS60．O％,P〉0．05）和不良反应率两组差异无统计学意义。结论HIFU是一种安全,无创,疗效确切地治疗胰腺癌的方法。HIFU联合吉西他滨化疗治疗不可切除胰腺癌不良反应无明显增加,且能有效地提高CBR和DCR,延长生存期。     

高强度聚焦超声热疗治疗31例胰腺癌的临床分析

目的探讨高强聚焦超声（HIFU）热疗对胰腺癌患者的疗效、安全性及对几种肿瘤标志物的影响。方法31例胰腺癌患者平均每例患者行7.2次HIFU治疗，对其进行疗效评价，观察患者的临床受益反应（CBR）、肿瘤客观评价、化学免疫分析法检测CA19—9、CA242和CEA浓度。结果31例胰腺癌患者中共20例临床受益，CBR牢达64．51％。治疗前-后CA19-9、CA242、CEA浓度差异具有统计学意义。在治疗过程中无明显副作用。结论高强聚焦超声热疗能控制肿瘤进展、改善生活质量、对肿瘤标志CA19-9、CA242、CEA有有明显下调作用，无明显不良反应。     

高强度聚焦超声联合白蛋白结合型紫杉醇治疗胰腺癌临床疗效观察

目的探讨高强度聚焦超声(high-intensity focused ultrasound,HIFU)联合白蛋白结合型紫杉醇治疗晚期胰腺癌临床疗效及不良反应情况。方法将38例无法手术切除的胰腺癌患者随机分为治疗组20例和对照组18例。对照组:单纯行白蛋白结合型紫杉醇治疗。治疗组:先行2个周期白蛋白结合型紫杉醇治疗,再行HIFU治疗。评价指标为:肿瘤客观疗效、疼痛缓解程度、生存期及不良反应发生情况。结果治疗组总体有效率、疼痛缓解率及中位生存期分别为75.0%、90.0%和4.5个月,均明显优于对照组(50.0%、44.4%和9.5个月),差异有统计学意义(P0.001)。两组均无Ⅲ~Ⅳ级不良反应发生。结论 HIFU联合白蛋白结合型紫杉醇治疗晚期胰腺癌可明显缓解癌性疼痛、改善生活质量、延长生存期,且具有安全性高的优点,值得临床推广。     

43例胰腺癌患者血清CA19-9、CA125、CEA水平检测及分析

目的 探讨血清肿瘤标志物CA19-9、CA125及癌胚抗原（CEA）联合检测对胰腺癌诊断及疗效监测的价值.方法 采用全自动电化学发光分析仪测定43例胰腺癌患者（胰腺癌组）及40例健康查体者（对照组）血清CA19-9、CA125及CEA水平,其中胰腺癌组手术前及术后1个月各测定1次;根据试剂厂家提供的参考值计算三种标志物诊断胰腺癌的敏感性、特异性及准确性.结果 胰腺癌组手术前后血清CA19-9、CA125及CEA水平均显著高于对照组（P＜0.01）,尤以术前为著（P＜0.05）;三种肿瘤标志物术后阳性率均显著低于术前（P＜0.05）,联合检测上述三种肿瘤标志物诊断胰腺癌的敏感性、特异性及准确性均显著高于单一标志物检测（P＜0.05）. 结论联合检测血清CA19-9、CA125、CEA水平对胰腺癌的辅助诊断、疗效判定、病情监测等均有重要价值.     

胰腺癌患者血清CEA、CA19-9和CA50水平变化及意义

目的观察胰腺癌患者血清癌胚抗原（CEA）、糖类抗原19-9（CA19-9）和CA50水平变化及其对胰腺癌分期和手术可切除性的术前预测价值。方法测定60例胰腺癌患者（胰癌组）血清CEA、CA19-9及CA50,根据手术和病理学检查判定TNM分期。以40例良性胰腺疾病患者作对照（对照组）,分析血清CEA、CA19-9、CA50水平与胰腺癌分期以及手术可切除性之间的关系。结果胰癌组血清CEA、CA19-9、CA50水平均明显高于对照组（P〈0.01）。胰癌组Ⅲ＋Ⅳ期患者的血清CEA、CA19-9、CA50水平明显高于Ⅰ＋Ⅱ期患者（P〈0.01）;姑息性手术患者的血清CEA、CA19-9、CA50水平显著高于根治性手术患者。结论血清CEA、CA19-9、CA50水平与胰腺癌分期有关,可作为判定胰腺癌能否行根治性手术切除的参考指标。     

高强度聚焦超声联合吉西他滨对老年中晚期胰腺癌肿瘤生长及预后的影响

目的探究老年中晚期胰腺癌采用高强度聚焦超声(HIFU)联用吉西他滨治疗的效果及患者的预后。方法 54例老年中晚期胰腺癌患者随机分为2组,观察组为HIFU+化疗组,采用HIFU联合静脉滴注吉西他滨治疗;对照组为单纯化疗组,采用静脉滴注吉西他滨治疗。比较两组患者治疗2个月后疼痛缓解程度、肿瘤体积变化、并发症的发生情况以及治疗后3、6个月的生存率。结果观察组患者治疗后疼痛缓解率明显高于对照组,治疗前后VAS评分、外周血CA199水平明显下降(P0.001)。观察组治疗后肿瘤体积明显缩小(P0.001)。治疗3个月后观察组生存率为100%,对照组生存率为92.0%,两组对比无统计学差异(P=0.121);治疗6个月后,观察组生存率为75.9%,对照组生存率为24.0%,两组生存率对比差异显著(P0.001)。观察组29例患者均未出现皮肤烧伤、胃肠道穿孔、胰瘘和出血等HIFU治疗并发症。结论 HIFU联用吉西他滨治疗老年中晚期胰腺癌可明显限制肿瘤生长,缩小肿瘤体积,减轻患者的疼痛症状,且并发症少,有效延长患者的生存期,具有良好的临床疗效。     

强度聚焦超声治疗老年胰腺癌的疗效观察

目的观察高强度聚焦超声（high intensity focused ultrasound,HIFU）对老年中晚期胰腺癌患者的治疗作用。方法52例老年中晚期胰腺癌患者,年龄60～83岁,平均年龄（70．8±5．1）岁,按随机表法分为HIFU＋化疗组和单纯化疗组。HIFU＋化疗组应用HIFU及吉西他滨静脉滴注;对照组单纯化疗组给予吉两他滨静脉滴注。观察治疗后2个月肿瘤体积变化、患者疼痛缓解程度和不良反应发生率,记录治疗后3个月和6个月的生存率。结果HIFU＋化疗组根据实体肿瘤疗效的客观评判标准（肿瘤消长）,完全缓解率（CR）＋部分缓解率（PR）为55．1％,高于单纯化疗组的26．1％（P=0．037）;HIFU＋化疗组疼痛缓解阳性改善率为69．O％,高于单纯化疗组的21．7％（P=0．001）;两组并发症无统计学差异;HIFU＋化疗组患者的3个月生存率为100％（29／29）,单纯化疗组为91．3％（21／23）,两组无统计学差异（P=0．109）;HIFU＋化疗组6个月生存率为72．4％（21／29）,较单纯化疗组的30．4％（7／23）增加（P=0．025）。结论HIFU作为一种绿色的治疗手段,联合吉西他滨化疗可以更有效地控制晚期胰腺癌的肿瘤生长,缓解患者疼痛．延长患者生存期,且无明显不良反应．是一种有效、安全的治疗方法。     

术中射频消融、125I放射性粒子植人联合区域性灌注化疗治疗中晚期胰腺癌

目的探讨术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌的疗效。方法回顾性分析2004年1月～2008年12月我院收治的34例中晚期胰腺癌患者的临床资料,分为2组,实验组16例采用术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗,对照组18例采用单纯区域性灌注化疗,对比2组患者治疗后疗效、疼痛缓解程度、生存期、不良反应及CA19-9变化。结果实验组治疗有效率（81．25％）高于对照组（27．78％）;实验组治疗后CA19-9低于治疗前及对照组;实验组9、12个月生存率及中位生存期高于对照组;实验组比对照组能够明显改善患者的疼痛症状。结论术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌可获得较好的疗效。     

术前多时相介入化疗在可切除性胰腺癌患者中的应用研究

目的研究术前多时相介入化疗在可切除性胰腺癌患者中的应用效果。方法选择2003年1月至2015年1月我院收治的可切除性胰腺癌138例,随机分为两组,每组各69例。对照组患者术前不进行介入化疗,直接采取手术治疗,于手术完成后开展介入化疗,每6周介入化疗一次,共治疗6次;观察组患者于术前先进行介入化疗,然后采取手术治疗,手术完成后再进行介入化疗,每6周介入化疗一次,共治疗6次。比较两组的无瘤生存期、1年、2年、3年生存率以及术后肝转移发生率;比较两组介入治疗前后的肿瘤标志物水平。结果观察组的无瘤生存期明显长于对照组(P0.05)。治疗后,两组的血清CA125、CA199、CA242以及CA50水平均明显降低,且观察组各指标均显著低于对照组(P0.05);两组恶心呕吐,转氨酶升高以及骨髓抑制等不良反应发生率相比无明显差异(P0.05)。结论多时相介入化疗可以有效抑制可切除性胰腺癌患者肿瘤细胞的生长,可以作为胰腺癌综合治疗的有效措施之一。     

Short and long term efficacy of high intensity focused ultrasound therapy for advanced hepatocellular carcinoma

BACKGROUND: The aim of this study was to investigate the short and long term efficacy of high intensity focused ultrasound therapy (HIFU) in patients with advanced hepatocellular carcinoma (HCC). METHODS: Patients with surgically unresectable HCC received either HIFU plus supportive treatment (HIFU group, n = 151) or supportive treatment only (control group, n = 30), according to their willingness. Short term efficacy, including improvement in tumor imaging parameters, decrease in serum alpha-fetoprotein (AFP) levels, symptom relief (i.e. Karnofsky Performance Status and numerical rating scales) and response rates, and long term efficacy, including an increase in survival rates and improvement of quality of life (QOL), was monitored. RESULTS: Tumor imaging parameters, serum AFP levels and symptom scores improved significantly in the HIFU group compared with the control group (all P < 0.05). In the HIFU group, a complete and a partial response were achieved in 28.5% (n = 43) and 60.3% (n = 91) of cases, respectively, while the rates were 0% and 16.7% (n = 5), respectively, in the control group. The overall response rate (88.8%) was significantly greater in the HIFU group (16.7%) than in the control group (P < 0.01). In addition, the 1- and 2-year survival rates were 50.0% and 30.9%, respectively, in the HIFU group, which were significantly greater than those (3.4% and 0%, respectively) in the control group (both P < 0.01). The QOL score was 83.1 +/- 8.0 at 3 months after HIFU, which was significantly greater than the pre-HIFU score (67.7 +/- 5.9) and the score at 3 months after treatment (69.0 +/- 8.5) in the control group (both P < 0.05). No severe complications occurred during and after HIFU. CONCLUSION: HIFU is an effective and safe ablation therapy with satisfactory short and long term efficacy for patients with advanced HCC.     

高强度聚焦超声联合人工液胸治疗不可切除小儿肝母细胞瘤短期疗效研究*

目的 探讨采用高强度聚焦超声(HIFU)联合人工液胸治疗不可切除的小儿肝母细胞瘤(HB)短期疗效。方法 2018年6月～2020年6月我院收治的不可切除的HB患儿48例,采用随机数字表法将患儿分为对照组24例和观察组24例,分别给予HIFU或HIFU联合人工液胸治疗,观察12 w。结果 在治疗12 w末,观察组有效率为87.5%,显著高于对照组的62.5%(P＜0.05);观察组血清ALT、AST和AFP水平分别为(72.6±26.1)U/L、(61.0±30.3)U/L和(43.1±5.3)μg/L,显著低于对照组【分别为(117.5±30.2)U/L、(116.6±37.8)U/L和(155.2±6.1)μg/L,P＜0.05】,而血红蛋白水平为(96.4±26.1)g/L,显著高于对照组【(90.7±23.6)g/L,P＜0.05】;两组血清IgM、IgG、IgA和补体C3、C4水平比较,差异无统计学意义(P＞0.05);在治疗期间,观察组发热、肋骨受损、皮肤烫伤、腹腔积液和创伤性湿肺等并发症发生率为4.2%,显著低于对照组的29.2%(P＜0.05)。结论 采用人工液胸保护下的HIFU治疗不可切除的HB患儿短期临床疗效确切,能有效降低并发症发生率,值得临床验证。     

吉西他滨联合高能聚焦超声治疗晚期胰腺癌效果的Meta分析

目的评价吉西他滨(Gem)联合高能聚焦超声(HIFU)治疗晚期胰腺癌的安全性和有效性。方法网上检索SCI、Cochrane数据库、Embase、Pubmed、万方数据、中国知网、CBM、VIP文献库,再辅助以扩展检索,将检索到的HIFU联合Gem治疗晚期胰腺癌的随机对照试验按照纳入标准筛选。采用Review Manager5.3进行Meta评价。非异质性数据使用固定效应模型;异质性按照干预方法进行亚组分析来解释异质性;如果仍然不能用亚组分析来解释,则采用随机效应模型。使用相对危险度(RR)及其95%可信区间(95%CI)作为评估指标,选取纳入研究数目多的结果绘制漏斗图。结果共纳入8篇随机对照试验(474例患者),试验组与对照组都接受Gem为基础的化疗,试验组加用HIFU治疗。试验组与对照组3、6、12个月的生存率RR值分别为1.07(95%CI:1.00~1.14)、2.19(95%CI:1.75~2.75)和2.35(95%CI:1.07~5.14)(P值均<0.05);肿瘤控制效果RR为1.64(95%CI:1.21~2.24)(P=0.002),疼痛控制效果RR为3.15(95%CI:2.45~4.05)(P<0.05);联合组与对照组在白细胞减少、胃肠道反应、肝损伤方面的RR分别为1.05(95%CI:0.85~1.30)、0.89(95%CI:0.56~1.42)、1.29(95%CI:0.95~1.75)(P值均>0.05)。因具有疼痛控制这一结局指标的研究数量最多,因此针对该指标绘制相关漏斗图,未见明显的偏倚风险。结论与Gem单药相比,联合HIFU能够增加患者的生存率,改善患者症状,且不良反应的发生与单药治疗相比无明显差异,值得进一步研究。     

高强度聚焦超声治疗老年原发性肝癌的有效性及安全性临床观察

目的评价高强度聚焦超声(HIFU)在老年原发性肝癌患者的有效性及安全性。方法纳入2014年1月-2016年12月期间在复旦大学附属华东医院肿瘤微创治疗部接受HIFU治疗的CNLC分期为Ⅱa期以内的老年原发性肝癌患者41例。回顾分析所有患者的临床资料、治疗疗效及不良反应,并随访患者的总体生存率(OS)。疗效根据1.1版实体瘤(RECIST)的评估标准进行评分,以不良事件通用标准4.0版(CTCAE 4.0)评估不良反应。结果患者在HIFU治疗后完全缓解和部分缓解分别为2例(4.9%)和29例(70.7%),稳定为8例(19.5%),进展为2例(4.9%)。总体缓解率为75.6%。在24个月的随访期,患者的中位生存时间为23个月;患者1年和2年生存率分别是87.8%和42.7%。多因素分析结果显示,ECOG评分1分(HR=3.71;95%CI=1.11~12.48;P=0.33)和多发病灶(HR=14.36;95%CI=1.69~46.26;P=0.015)是患者HIFU治疗预后的独立危险因素。没有≥3级不良事件。HIFU治疗过程中,少数患者(n=9,22.0%)出现皮肤发红,可自行愈合;1例出现发热;1例出现轻微的胸壁疼痛,予非甾体类药物镇痛,3 d后停药;大部分患者出现轻到中度疼痛,治疗停止后疼痛自行缓解。没有观察到皮肤烧灼伤,未发现胃肠道穿孔、出血等不良反应。结论HIFU作为一种无创的治疗方法,能够有效的控制原发性肝癌的生长,缓解患者疼痛,延长患者生存期,无明显不良反应,是老年原发性肝癌安全有效的治疗选择之一。     

Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer

AIM: To evaluate the safety and clinical application of high-intensity focused ultrasound (HIFU) therapy for unresectable pancreatic cancer (PC).METHODS: Thirty PC patients (16 cases in stage III and 14 cases in stage IV) with visualized pancreatic tumors were admitted for HIFU therapy as an optional local therapy in addition to systemic chemotherapy or chemoradiotherapy. Informed consent was obtained. This study began at the end of 2008 and was approved by the ethics committee of our hospital [Institutional Review Board (IRB): 890]. The HIFU device used was the FEP-BY02 (Yuande Bio-Medical Engineering, Beijing, China).RESULTS: The mean tumor size after HIFU therapy changed to 30.9 ± 1.7 mm from 31.7 ± 1.7 mm at pre-therapy. There were no significant changes in tumor size, mean number of treatment sessions (2.7 ± 0.1 mm), or mean total treatment time (2.4 ± 0.1 h). The rate of symptom relief effect was 66.7%. The effectiveness of primary lesion treatment was as follows: complete response, 0; partial response, 4; stable disease, 22; progressive disease, 4. Treatment after HIFU therapy included 2 operations, 24 chemotherapy treatments, and 4 best supportive care treatments. Adverse events occurred in 10% of cases, namely pseudocyst formation in 2 cases and mild pancreatitis development in 1. However, no severe adverse events occurred in this study.CONCLUSION: We suggest that HIFU therapy is safe and has the potential to be a new method of combination therapy for PC.     

High-intensity focused ultrasound ablation:An effective bridging therapy for hepatocellular carcinoma patients

AIM:To analyze whether high-intensity focused ultrasound(HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma(HCC).METHODS:From January 2007 to December 2010,49 consecutive HCC patients were listed for liver transplantation(UCSF criteria).The median waiting time for transplantation was 9.5 mo.Twenty-nine patients received transarterial chemoembolization(TACE) as a bringing therapy and 16 patients received no treatment before transplantation.Five patients received HIFU ablation as a bridging therapy.Another five patients with the same tumor staging(within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison.Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores,tumor size and number,and cause of cirrhosis.RESULTS:The HIFU group and TACE group showed no difference in terms of tumor size and tumor number.One patient in the HIFU group and no patient in the TACE group had gross ascites.The median hospital stay was 1 d(range,1-21 d) in the TACE group and two days(range,1-9 d) in the HIFU group(P < 0.000).No HIFU-related complication occurred.In the HIFU group,nine patients(90%) had complete response and one patient(10%) had partial response to the treatment.In the TACE group,only one patient(3%) had response to the treatment while 14 patients(48%) had stable disease and 14 patients(48%) had progressive disease(P = 0.00).Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list(P = 0.559).CONCLUSION:HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis.It may reduce the drop-out rate of liver transplant candidate.     

经导管肝动脉化疗栓塞术联合三维适形放疗治疗巨大原发性肝癌疗效分析

目的 探讨经导管肝动脉化疗栓塞术（TACE）联合三维适形放疗（3D-CRT）治疗巨大原发性肝癌患者的疗效。方法 回顾性分析2009年1月～2015年1月我院诊治的147例无法手术切除的巨大（直径≥10cm）原发性肝癌。根据治疗方案不同,分为TACE联合3D-CRT治疗63例和TACE治疗84例,比较分析两组患者治疗效果,并记录治疗期间不良反应发生情况。结果 TACE联合3D-CRT组有效率为65.1%,显著高于TACE组的40.5%（P＜0.05）;TACE联合3D-CRT组和单纯TACE组6 m、1 a、2 a生存率分别为84.1%、55.6%、27.0%和59.5%、38.1%、19.1%,其中两组6 m和1 a年生存率比较有统计学差异（P＜0.05）;两组不良反应发生率比较无显著差异。结论 TACE联合3D-CRT治疗无法手术切除的巨大原发性肝癌具有良好的临床疗效。     

The current potential of high-intensity focused ultrasound for pancreatic carcinoma

Introduction

Pancreatic carcinoma has one of the poorest prognoses among malignant tumors. Many pancreatic carcinoma patients who undergo common treatments, such as surgery, radio-chemotherapy and chemotherapy, gained little benefit because of the histological characteristics.

Materials and methods

HIFU is a new technique of noninvasive treatment for unresectable pancreatic carcinoma. HIFU has the ability to ablate the deep tissues inside body from an external source using high-intensity focused ultrasound. The effects of HIFU can result in cell destruction and tissue necrosis.

Results

Results from study in China in 251 patients with advanced pancreatic carcinoma suggested that HIFU treatment could reduce the size of tumors without causing complications and prolong survival. Moreover, according to some reports from China, HIFU treatment is suggested to be useful as the one of palliative treatments for unresectable pancreatic carcinoma. Our case of HIFU therapy for pancreatic carcinoma is presented including pathological findings in this paper. The results suggested that HIFU treatment might be effective in controlling local tumor.

Conclusion

HIFU therapy may have the possibility of becoming one of the combination therapies for treating pancreatic carcinoma in the future.     

高强度聚焦超声波对细粒棘球绦虫原头节的杀伤效应

目的 探索高强度聚焦超声波(HIFU)对体外分离的细粒棘球绦虫原头节的急、慢性杀灭作用.方法 实验对象为感染细粒棘球蚴病的羊肝原头节.选择声功率为0(对照组)、25、50、100、200、250 W的超声波辐照离体原头节,每种功率辐照时间分别为5、10、20、30、40、50、60 s,观察HIFU对离体原头节的即刻杀灭作用.以不致即刻杀伤的超声剂量作用原头节后,观察HIFU对原头节的迟发性生长抑制作用.光镜下,根据台盼蓝排斥法染色结果及观察原头节形态变化计算原头节死亡率.结果 HIFU对原头节有明显的急性杀伤作用,在一定的功率和时间范围内有剂量-效应关系,不同功率和辐照时间对原头节死亡率的影响,组间比较差异均有统计学意义(F值分别为5201.59、1865.65,P＜0.05),且功率与辐照时间之间存在交互效应(F=214.50,P＜0.05).随着超声照射剂量增大,其生物学效应越明显,声功率≥200 W的短时照射即可致原头节全部即刻死亡,部分原头节被打碎.以不致原头节即刻杀伤的超声照射后,体外培养2～7 d的原头节死亡率均较对照组明显增高(P＜0.05),随超声剂量的增大抑制原头节生长作用增强,培养第2天开始,50 W×10 s组强于25 W×20 s组(P＜0.05).结论 HIFU能够即刻杀灭原头节并能抑制原头节在体外的生长.