高强度聚焦超声对恶性实体肿瘤血管的破坏作用

目的：探讨高强度聚焦超声（HIFU）体外破坏恶性实体肿瘤血管的临床影像学变化和病理学变化。方法：HIFU治疗恶性实体肿瘤患者164例，通过数字减影血管造影、彩超、放射性核素显影分析肿瘤血管治疗前后的功能状态；30例患者治疗后常规外科手术，观察肿瘤血管的病理学变化。结果：临床影像学检查显示与治疗前比较，治疗后肿瘤异常血管网被破坏，肿瘤内血供减少或消失；光镜下肿瘤毛细血管、小血管管壁结构出现不可逆性损伤表现，腔内有血栓形成。结论：HIFU能从体外破坏肿瘤血管，加强了HIFU杀死肿瘤细胞的直接效应，这种选择性破坏血管作用有重要的临床意义。     

高强度聚焦超声在肿瘤治疗中的应用

目的 探讨高强度聚焦超声在肿瘤治疗中的意义及其局限性。方法 用文献综述的方法对高强度聚焦超声在肿瘤治疗中的应用及其局限性进行讨论。结果 高强度聚焦超声能将超声波聚焦于机体深部，在极短的时间内使靶区温度骤升，直接杀死靶区肿瘤，而对于靶区外组织无损伤。具有并发症少、全身反应小、可重复治疗等优势。但其应用也受影像学技术、脏器的运动、含气腔道和骨性组织等因素的影响。结论 高强度聚焦超声是一种非侵入性局部治疗肿瘤的方法，有巨大的应用前景。     

高强度聚焦超声体外治疗恶性肿瘤的护理

高强度聚焦超声 (ＨｉｇｈＩｎｔｅｎｓｉｔｙＦｏｃｕｓｅｄＵｌｔｒａｓｏｕｎｄ ,ＨＩＦＵ)治疗肿瘤技术是近几年来发展的新领域 ,该技术利用超声波的组织穿透和可聚焦等物理特性 ,将体外低能量超声波聚焦在体内肿瘤病灶 ,通过焦点区高能量超声波产生的高温、机械效应等 ,使靶区内组织完全毁损[1] 。我科自2 0 0 1年 7月至 2 0 0 2年 4月应用ＨＩＦＵ技术治疗恶性肿瘤病人12 0例 ,取得良好疗效。1　临床资料　　一般资料 :12 0例中 ,男 78例、女 4 2例 ,年龄 976岁 ,平均 4 7 3岁。其中肝癌 78例 ,乳腺癌 2例 ,恶性骨肿瘤 11例 ,软组织肉…     

高强度体外聚焦超声治疗腹部恶性肿瘤29例初步报告

目的：观察FEP－BY01肿瘤热治疗机治疗腹部实体肿瘤的效果及并发症。方法：FEP－BY01肿瘤热疗治疗治疗腹部各种实体肿瘤29例，并将其分成空腔脏器肿瘤和实质脏器肿瘤两组，分别观察治疗效果。结果：空腔脏器肿瘤7例，肿瘤总值消失率为6／7，NC为1／7，实质脏器肿瘤22例，显效率40．9％（9／22），有效率45．5％（10／22），无效率13．6％（3／22）。全组治疗无穿孔，大出血等并发症。结论：高强度体外聚焦超声技术对治疗腹部肿瘤，是一项效果明显又十分安全的新型局部治疗技术。     

高强度聚焦超声对W256肝癌荷鼠淋巴细胞活性的影响

我们应用高强度聚焦超声 (ＨＩＦＵ )治疗Ｗ 2 5 6肝癌荷鼠 ,并通过四唑蓝(ＭＴＴ)比色法观察荷癌鼠外周血淋巴细胞杀癌细胞活性的变化 ,旨在通过淋巴细胞功能的变化反映高强度聚焦超声对荷癌鼠免疫的影响 ,为其临床应用提供依据。现将结果报道如下。一、材料和方法1.模型的制作 :选用Ｗｉｓｔａｒ大鼠 ,雌雄各半 ,体重 15 0～ 2 5 0 ｇ。质量分数为 3 %戊巴比妥钠 (3 0～ 40ｍｇ/ｋｇ体重 )腹腔注射麻醉。在其肝左叶埋置 1ｍｍ3大小的Ｗ 2 5 6癌块。接种 7～ 10ｄ后可长成直径 0 .5～ 1.0ｃｍ大小的实体癌 ,即可作为Ｗ 2 5 6肝癌荷鼠模型。…     

前列腺癌的高强度聚焦超声治疗

前列腺癌（prostate cancer，PCa）的流行病学显示，前列腺癌发病率正逐年增高。美国的前列腺癌发病率已超过肺癌，据美国抗癌协会估计，2004年美国大约有230110例新发前列腺癌，有29900例将死于此病。在欧洲，每年新发前列腺癌病例大约有260万人，前列腺癌病人占全部男性癌症病人数的11％，占全部男性癌症死亡人数的9％。     

高强度聚焦超声治疗的麻醉处理

高强度聚焦超声(high intensity focused ultrasound，HIFU)又称为超声聚焦刀，是近年应用于临床的一种非侵入性肿瘤局部灭活技术。我院自1999年12月至2003年5月，应用HIFU治疗实体瘤315例，取得了良好临床效果。由于HIFU对人体生理有较大影响，因此，该技术的开展给临床麻醉提出了又一新课题，现报告如下。     

高强度聚焦超声治疗兔肾癌细胞株VX2的CT动态观察

目的 评估CT在高强度聚焦超声治疗兔VX2肾癌近期随访中的价值。方法 纯种新西兰白兔14只，建立原位肾癌动物模型。所有兔行CT检查后随机分成2组：对照组（5只），行高强度聚焦超声（HIFU）假照射，1月后CT检查；治疗组（9只），HIFU治疗后1周、1个月和2个月行CT检查。结果 （1）肿瘤强化：治疗前，所有肿瘤都有强化。对照组肿瘤在假照射后1个月依然都有强化；治疗组在治疗后1周，66．7％的肿瘤强化消失；治疗后1个月，88．9％的肿瘤强化消失；治疗后2个月和1个月相比肿瘤强化无明显变化。（2）肿瘤钙化：治疗后1月，治疗组77．8％的肿瘤出现钙化，对照组肿瘤始终无钙化。（3）肿瘤体积：对照组兔处死前的末次CT检查测得肿瘤体积和解剖后测得肿瘤体积比较，配对t检验，差异无统计学意义（P＞0．05）；同法比较治疗组肿瘤体积，差异无统计学意义（P＞0．05）。（4）治疗前CT测得体积和HIFU治疗点数之间有较好相关性（r=0．667，P＜0．05）。（5）病理观察：治疗后肿瘤细胞凝固性坏死，随访期中示纤维化、钙化改变；未治疗肿瘤生长旺盛。病理和CT结果一致。结论 CT检查可以为制定HIFU治疗计划提供参考；CT可以作为HIFU治疗肾癌后良好的随访手段；CT随访宜在治疗后1个月进行。     

高强度体外聚焦超声治疗腹腔和盆腔恶生肿瘤140例初步报告

目的 了解ＦＥＰ－ＢＹ０１恶性肿瘤热治疗机治疗腹腔和盆腔恶生实体肿瘤的效果及安全性。方法 应用ＦＥＰ－ＢＹ０１恶性肿瘤热治疗机治疗腹腔和盆腔各种进展期实体恶性肿瘤１４０例，并将其分成空腔脏器恶性肿瘤和实质脏器恶生肿瘤两组。结果 空腔脏器恶性肿瘤４１例，恶生肿瘤完全消失率为６６％（２２／４１）、恶性肿瘤部分消失率为３４％（１４／４１）；实质脏器恶生肿瘤９９例，显效率完全消失率为６６％（２２／４１）、     

高强度聚焦超声肿瘤治疗系统治疗乳腺癌的护理

对３７例乳腺癌患者采用高强度聚焦超声肿瘤治疗系统（ＨＩＦＵ）进行保乳无创性治疗。一次性治疗后３－７ｄ行肿块穿刺作病理学检查，肿瘤细胞出现不同程度的变性坏死：随访１－３０个月，Ｂ超复查肿块缩小率１００％；彩色多普勒复查肿瘤内血流减少或消失，肿瘤内回声增强；无１例复发及转移。护理要点：①治疗前行皮肤脱脂，脱气，准备脱气水；②术中水温调控在２０－２５℃；③术后注意观察皮肤情况，妥善处理水疱，嘱患者穿宽松     

高强度聚焦超声肿瘤消融术麻醉管理的研究进展

高强度聚焦超声（HIFU）是一种无创的局部热消融技术,是治疗实体肿瘤的一种新方法,其安全性和可靠性已得到证实,目前已广泛应用于肝脏、胰腺、子宫以及前列腺等器官肿瘤的治疗。由于采用HIFU进行肿瘤治疗的患者通常处于肿瘤的终末期,全身情况较差,麻醉方式的选择须十分谨慎,不同部位的肿瘤其麻醉关注点也有所不同。本文就各种HIFU肿瘤消融术麻醉方式的选择、相关并发症和麻醉管理要点进行综述。     

Extracorporeal application of high-intensity focused ultrasound for prostatic tissue ablation

OBJECTIVE: To investigate the efficacy and safety of extracorporeal prostatic tissue ablation using high-intensity focused ultrasound (HIFU) in vivo in animals, and in a clinical feasibility study in men, as this is an investigational minimally invasive treatment alternative for locally confined prostatic carcinoma, but may have significant side-effects. PATIENTS, MATERIALS AND METHODS: Ultrasound (1.04 MHz excitation frequency) was generated by an extracorporeal cylindrical piezo-ceramic element and focused by a paraboloidal reflector to a focal size of 32 x 4 mm. The focal distance and aperture diameter were both 100 mm. HIFU was applied extracorporeally at different intensities and pulse duration (up to 6 s) to 11 dog prostates in vivo (median intensity 1192 W/cm2) and eight patients (median intensity 3278 W/cm2, range 2384-3576) under general anaesthesia. The lesions were assessed macroscopically and histologically after HIFU and any side-effects evaluated. RESULTS: Thermoablation was feasible in vivo and in all patients. Macroscopic analysis and histology showed sharply demarcated coagulative necrosis. Side-effects, including skin and rectal burns, occurred only after transvesical application in the in vivo study. There were no side-effects in patients after perineal application. CONCLUSION: Extracorporeal HIFU is technically feasible and induces sharply demarcated tissue damage in the prostate. From the early results of this phase 1 study, the perineal approach seems to be safe.     

磁共振成像引导下高强度聚焦超声治疗子宫平滑肌瘤的研究进展

目的磁共振成像引导下高强度聚焦超声(MR-HIFU)治疗子宫平滑肌瘤为育龄期症状性子宫平滑肌瘤患者提供了一种安全、有效、完全非侵入性保留子宫的治疗技术。本文对MR-HIFU治疗子宫平滑肌瘤的临床应用、疗效及研究进展等进行综述。     

Extracorporeally induced ablation of renal tissue by high-intensity focused ultrasound

OBJECTIVE: To investigate the safety and the effects on healthy renal tissue of high-intensity focused ultrasound (HIFU) applied extracorporeally. PATIENTS, MATERIALS AND METHODS: Ultrasound waves (1.04 MHz) created by a cylindrical piezo-ceramic element were focused by a parabolic reflector to a physical focus size of 32 x 4 mm (-6 dB). For an in vivo study, HIFU was applied to the healthy tissue of 24 kidneys, monitored by ultrasonography, with a maximum power of 400 W and a spatially averaged intensity (ISAL) in the focus of 1192 W/cm(2). Fourteen kidneys were removed immediately after ablation to evaluate the side-effects and the effects in the focal zone, and 10 kidneys were removed delayed after 1, 7 and 10 days. The clinical study consisted of 19 patients requiring radical nephrectomy for a renal tumour. HIFU was applied to the healthy tissue of 19 kidneys (up to 1600 W, I(SAL) = 4768 W/cm(2)) before proceeding with the radical nephrectomy. RESULTS: There were no major complications after applying HIFU to the 43 kidneys. Side-effects included skin burns (grade 3) in two patients. During the follow-up there were no further HIFU-specific side-effects. In one case (in vivo study) there was a thermal lesion of the small intestine, which was due to mis-focusing. HIFU effects in the focal zone immediately after application were: interstitial haemorrhages, fibre rupture, shrinking of the collagen fibres, and coagulation necrosis. These effects occurred sporadically, and their number and size did not correspond to the number of HIFU pulses applied. After 7 and 10 days, there was a well-demarcated coagulation necrosis in vivo. CONCLUSION: Using this device, extracorporeally applied HIFU can ablate healthy kidney tissue in vivo in combination with diagnostic online ultrasonography. The technique is safe and resulted only in minor complications (skin burns). Refinements in the technology are essential to establish HIFU as a noninvasive treatment option that allows complete and reliable tissue ablation.     

高强度聚焦超声定位损伤香猪肝脏组织的病理转归研究

目的观察HIFU无创性定位损伤深部实质脏器组织的有效性和可行性。方法采用GL-1型HIFU治疗样机（1．6MHz,13153W／cm2,3s）对28头小型香猪肝脏组织进行定位损伤。分别于处理后当天、3无、7天、14天、21天和28天取活俭进行病理观察。结果HIFU处理当天（即刻）,光、电镜下靶区肝细胞即出现不可逆变性坏死。3天后出现明显的凝固性坏死,与周围组织分界十分清晰。随后凝固性坏死组织逐渐液化、吸收。28天靶区由外至内逐渐被新生肝组织替代。结论HIFU无创性定位切除体内深部实质脏器肝脏组织是有效和可行的,为临床肿瘤的HIFU治疗提供了重要的实验依据。     

高强聚焦超声(HIFU)无创治疗肿瘤技术的崛起

20世纪40年代,美国学者首次提出了高强聚焦超声治疗技术的概念,并进行了初步的工程和临床研究.70、80年代间,治疗肿瘤的温热疗法曾盛行一时.90年代之后,高强聚焦超声外科肿瘤治疗技术在国际上重新崛起,我国率先推出了大型高强聚焦超声肿瘤治疗系统,并成功地应用于临床治疗乳腺癌、骨肿瘤、肝癌等多种实体肿瘤.迄今,该"JC型高强聚焦超声肿瘤治疗系统"已出口到英国、意大利、西班牙、日本、韩国等许多欧亚国家,在诸如欧洲肿瘤治疗中心等20多个医疗中心运行,治疗肿瘤患者达数万例.我国持续保持着引领世界超声无创治疗技术发展的领先地位.

Abstract：

In the 40 years of last centry American scientists put forward a concep of high intensity focused ultrasound (HIFU) therapeutic technique and had done some technical and clinical studies. Since 90 years the HIFU surgery technique treating tumors anew rised abruptly in the world. China firstly put out a comprehensive HIFU tumor treating sistem and successfully treated many solid tumors such as breast cancer, bone tumor, liver cancer etc.. Now the treating sistem has already exported to England, Italy,Spain, Japan, Colea etc. and treated tens thousands tumor patients. In the field of noninvasive ultrasound treating tumor technique China has continually kept the leading position in the world.     

高强度聚焦超声治疗晚期胰腺癌128例分析

目的 评价高强度聚焦超声(HIFU)治疗晚期胰腺癌的作用、安全性和有效性.方法 分析了128例晚期胰腺癌患者(Ⅲ期41例,Ⅳ期87例)接受HIFU治疗,通过临床症状、实验室检查、影像学变化和生存期等观察疗效.结果 全组病例未发生严重不良反应,22.9％患者癌抗原19-9下降,疼痛缓解,有效率为72.5％.局灶近期疗效为部分缓解11.7％,稳定70.3％,进展18.0％.1年生存率为16.7％,中位生存期为7.0个月.其中Ⅲ期患者1年生存率为28.5％,中位生存期为9.0个月;Ⅳ期患者1年生存率为10.8％,中位生存期为6.0个月.结论 HIFU治疗能够有效稳定瘤灶、缓解疼痛、延长患者生存期且不良反应少,显示了良好的临床价值.     

聚焦超声消融治疗胰腺癌的临床观察

目的探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)消融治疗胰腺癌的疗效和安全性.方法采用JC型高强度聚焦超声治疗系统,消融治疗44例胰腺癌患者.观察治疗前后的影像学变化及临床症状,评价HIFU治疗的疼痛缓解程度、生存期及不良反应.结果44例患者经HIFU治疗后,疼痛缓解率为94.74%,1、3、5年生存率分别为15.91%、6.82%、2.27%,中位生存时间为8个月(3～71个月).无上消化道出血或胃肠穿孔等严重并发症.增强CT或MRI显示HIFU治疗区内组织消融.结论HIFU是一种治疗胰腺癌的有效方法.该法无创、安全性较高、止痛效果明显,适合病情较重、不能耐受其他方法治疗的患者.     

Treatment of localized prostate cancer using high-intensity focused ultrasound

OBJECTIVE: To evaluate the biochemical disease-free survival (DFS), predictors of clinical outcome and morbidity of patients with localized prostate cancer treated with high-intensity focused ultrasound (HIFU), a noninvasive treatment that induces complete coagulative necrosis of a tumour at depth through the intact skin. PATIENTS AND METHODS: In all, 63 patients with stage T1c-2bN0M0 localized prostate cancer underwent HIFU using the Sonablate system (Focus Surgery, Inc., Indianapolis, IN, USA). None of the patients received neoadjuvant and/or adjuvant therapy. Biochemical recurrence was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology consensus definition, i.e. three consecutive increases in prostate-specific antigen (PSA) level after the nadir. The median (range) age, PSA level and follow-up were 71 (45-87) years, 8.5 (3.39-57.0) ng/mL and 22.0 (3-63) months, respectively. RESULTS: The overall biochemical disease-free rate was 75% (47 patients). The 3-year biochemical DFS rates for patients with a PSA level before HIFU of <10, 10.01-20 and >20 ng/mL were 82%, 62% and 20% (P < 0.001), respectively. The 3-year biochemical DFS rates for patients with a PSA nadir of <0.2, 0.21-1 and >1 ng/mL were 100%, 74% and 21% (P < 0.001), respectively. Final follow-up sextant biopsies showed that 55 (87%) of the patients were cancer-free. Multivariate analysis showed that the PSA nadir (P < 0.001) was a significant independent predictor of relapse. CONCLUSION: HIFU therapy appears to be a safe, effective and minimally invasive therapy for patients with localized prostate cancer, and the PSA nadir is a useful predictor of clinical outcome.