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。     

高强度聚焦超声联合化疗治疗恶性肿瘤的初步疗效研究

目的探讨高强度聚焦超声(high intensive focused ultrasound,HIFU)联合介入化疗栓塞或全身静脉化疗治疗恶性实体肿瘤的近期疗效. 方法 2001年7月～2002年12月,对84例恶性实体肿瘤先介入化疗栓塞或全身静脉化疗,再行HIFU治疗,观察治疗前后患者临床症状、肝功能(ALT、AST)、影像学(ECT、MRI或CT)的变化. 结果联合治疗后患者临床症状缓解率92.5%(62/67);56例肝癌ALT、AST异常降至正常水平分别占58.9%(33/56)、66.1%(37/56),AFP降低＞50%占71.9%(23/32);MRI或CT示肿瘤坏死范围＞50%占91.7%(77/84),其中＞80%占61.9%(52/84),肿瘤坏死范围＜50%占8.3%(7/84). 结论 HIFU联合介入化疗栓塞或全身静脉化疗治疗恶性实体肿瘤近期疗效满意.     

高强度聚焦超声治疗55例原发性肝癌后的早期影像学变化

目的：研究高强度聚焦超声（HIFU）治疗原发性肝癌（PLC）的早期影像学变化，为建立HIFU治疗肝癌的评价标准提供依据。方法：HIFU治疗本组55例PLC病人，观察治疗前后彩色多普勒超声、DSA、CT或MRI的变化。结果：与治疗前比较，经HIFU治疗后1-2周内肝癌出现治疗有效的影像学变化。其中，MRI是评价疗效的最佳检查方法，主要表现为T1和T2加权相信号的变化，以及动态增强相癌灶血液供应消失，边缘出现环状薄层的强化带。结论：MRI能及时判断HIFU是否完全灭活肝癌，治疗区有无残存癌组织和确定治疗范围。     

经直肠高强度聚焦超声破坏犬前列腺组织的实验研究

目的探讨经直肠高强度聚焦超声(high-intensity focused ultrasound,HIFU)破坏犬前列腺组织的的安全性、可行性和有效性。方法采用美国Focus Surgery公司生产的第三代HIFUSonablate-500型治疗仪,对16只犬的前列腺进行消融处理,在消融术前,术后30min、30d、60d和180d,经直肠超声观察前列腺和前列腺部尿道的影像学变化;切取前列腺及临近组织和器官,观察其组织病理学变化。结果HIFU前列腺消融术前,前列腺体积为(6.50±3.12)cm3,前列腺部尿道的最大宽度为(0.59±0.11)cm;HIFU消融术60天后前列腺体积为(4.13±2.03)cm3,前列腺部尿道最大宽度为(2.57±0.98)cm。HIFU前列腺消融术后组织学检查,可见前列腺靶区内腺体腺上皮及基质细胞发生均匀性凝固性坏死,60d后消融区的坏死组织脱落,前列腺部尿道呈囊腔状。HIFU前列腺消融区凝固性坏死与正常前列腺组织分界清楚,消融区以外的前列腺及临近组织和器官均无副损伤。HIFU前列腺消融术后并发症主要有尿潴留、尿频和血尿,各实验犬均未发生尿道直肠瘘等并发症。结论HIFU前列腺消融术可彻底破坏消融区的前列腺组织,显著增加前列腺部尿道宽度,对消融区以外的临近组织和器官无副损伤。HIFU前列腺消融术,有望成为临床治疗前列腺疾病的一种可选择的、安全和有效的微创治疗方法。     

高强度聚焦超声治疗肝包虫病

<正>高强度聚焦超声(HIFU)是近年来崛起的一种微创治疗方式,其原理是将体外的低能量超声波,经超声聚焦刀准确聚焦于靶组织,使能量得到数千倍放大,通过聚焦特定靶区的特性,产生瞬间高温(65~100℃)和空化效应,令靶组织凝固性坏死,空化效应使细胞膜及核膜破裂,失去扩散能力。在组织病理学上表现为凝固性坏死,从而达到破坏病变的目的。HIFU所产生的高温效应、空化效应、机械效应、超声生化效应等使靶组织凝固性坏死,失去     

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.     

高强度聚焦超声联合丝裂霉素治疗小鼠膀胱肿瘤的实验研究

目的　研究高强度聚焦超声 (HIFU)联合丝裂霉素对小鼠膀胱肿瘤的治疗作用和协同效应。　方法　制作小鼠膀胱肿瘤 (BTT739)皮下种植模型共 37只 ,随机分对照组、低剂量化疗组、高剂量化疗组、HIFU治疗组和HIFU联合化疗组。观察两周内种植瘤体积增长情况 ,计算肿瘤体积倍增时间 ,并作出生长曲线。摘除肿瘤瘤块进行病理学检查。　结果　HIFU联合化疗组对小鼠肿瘤的抑制作用优于单独化疗组和HIFU治疗组。病理学检查发现HIFU造成肿瘤组织大片凝固性坏死 ,肿瘤边缘及坏死区之间有少量活细胞残留 ,但凋亡细胞明显增多 ,增殖细胞核抗原 (PCNA)阳性率降低。　结论　HIFU和丝裂霉素联合治疗对小鼠肿瘤的抑制作用存在显著的协同效应 (P <0 0 1)。HIFU对小鼠肿瘤的抑制作用 ,除杀灭肿瘤细胞外 ,还发生肿瘤细胞凋亡现象。     

高强度聚焦超声治疗高危前列腺增生症的临床疗效

目的 评价高强度聚焦超声（HIFU）治疗高危前列腺增生症的近期疗效及安全性。方法 选择高危前列腺增生症患者102例，超声定位实时监视下，从体外将高能量超声聚焦于增生的前列腺组织，应用FEP-BY02型高强度聚焦超声治疗机进行HIFU治疗，治疗后定期随访观察患者临床症状、体征及瘤体超声影像学变化。结果 102例患者治疗后近期总有效率为92.2%（显效＋有效＋部分有效），其中显效11例（10.8%），有效43例（42.2%），部分有效40例（39.2%），无效8例（7.8%）。结论 HIFU体外治疗可作为一种无手术创伤治疗高危前列腺增生症安全有效方法之一。     

HIFU与TACE联合治疗肝癌的近期疗效

高强度聚焦超声（high intensity focused ultrasound，HIFU）是近年发展起来的一项微创治疗肿瘤的新技术和新方法，它是利用体外低密度的超声波在肿瘤靶区聚焦，使靶区温度在0．5-1．0s骤升至65-100℃。对靶区组织起直接杀伤破坏作用。我们于2001年7月至2003年7月通过HIFU与经导管动脉栓塞化疗（transcatheter arterial chemoembolization，TACE）联合治疗肝癌68例，已取得明显疗效。报道如下。     

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。     

高强度聚焦超声治疗兔肾VX2肿瘤的实验研究

目的探讨高强度聚焦超声（ＨＩＦＵ）治疗肾肿瘤的效果。方法采用兔肾ＶＸ２肿瘤模型进行ＨＩＦＵ辐照。辐照后不同时期处死动物以观察其病理变化。另以辐照组及对照组动物各６只,于２周后处死,比较肿瘤生长及肺转移的情况。结果ＨＩＦＵ辐照后肿瘤细胞立即发生凝固性坏死,电镜下亦见到不可逆的破坏。２周后有４只动物的肿瘤原发灶已被完全破坏;另２只靶区外有少量肿瘤残存,其体积为６２．８ｍｍ３和９．４ｍｍ３,而对照组的肿瘤平均体积为（１７５１．１±３５３．７）ｍｍ３。辐照组有２只（３３％）发生肺转移,转移结节数为９和３;对照组全部发生肺转移,转移结节数为５２±３４。两组差异有显著性。结论ＨＩＦＵ对兔肾ＶＸ２肿瘤有很强的杀伤作用。     

High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study

BACKGROUND: High-intensity focused ultrasound (HIFU) consists of focused ultrasound waves emitted from a transducer that are capable of inducing tissue damage. Experimental studies have shown clear damage of malignant tissue exposed to HIFU, but knowledge of in vivo effects is limited. We studied the safety and efficacy of HIFU in patients with a T1-2 N0) M0 prostate carcinoma. METHODS: HIFU treatment was performed under general anesthesia with the Ablatherm device (Technomed Medical Systems, Lyon, France), 7-12 days prior to radical prostatectomy. Only the lobe in which carcinoma was confirmed was treated. The radical prostatectomy specimen was examined histopathologically, and the changes were compared with treatment goals. RESULTS: So far, 9 patients have been treated. On histology, a sharp delineation was noted between areas treated with HIFU and untreated areas. On the dorsal border, however, incomplete destruction of tissue was noted, and in 2 cases a small residual tumor was seen in this region. In all cases complete necrosis was seen in the treated region. CONCLUSIONS: Histology reports of radical prostatectomy specimens of patients operated 7-12 days after HIFU treatment showed marked and complete necrosis in the treated area. Due to incomplete tissue destruction at the dorsal side, however, a small focus of residual vital tumor was found in 2 of 9 patients.     

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。     

Ultrasonidos extracorpóreos de alta intensidad: alternativa terapéutica del tumor renal

ObjectivesHigh intensity focused ultrasound (HIFU) is known to be used for the treatment of solid tumors in minimally invasive procedures. Transducers allowing for application of ultrasound from an extracorporeal focus have recently been developed. A review is provided of the development, physical principles, and current status of this therapy, and our early experience with it for the treatment of renal tumors is reported.Materials and methodsExtracorporeal HIFU is currently being used for the treatment of tumors (mainly hepatic, gynecological, and bone tumors), and has been started to be used for renal tumors with good results. A literature review (structured search in the online MEDLINE electronic base) of the physical principles of this treatment and its biological action is provided. The therapeutic procedure used in the first few patients with renal carcinoma successfully treated with HIFU at our hospital is reported.ResultsThis therapy has been successfully used to treat solid tumors at several centers in Europe, America, and Asia. Our center has a wide experience in treatment of gynecological tumors using extracorporeal HIFU, and has already treated renal tumors with no complications, although follow-up is still short.ConclusionsExtracorporeal use of this energy appears as a new option among non-invasive therapies for renal cancer in selected cases. A low complication rate has been noted, but much longer follow-up times are required for assessment of oncological results.     

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.     

Microbubbles improve the ablation efficiency of extracorporeal high intensity focused ultrasound against kidney tissues

Objective  The necrosis rate is low when ablating kidney tissues with extracorporeal high intensity focused ultrasound (HIFU), and this drawback has been limiting the application of ultrasonic therapy. The aim of the present study was to determine whether microbubbles increased the ablation efficiency in vivo. Methods  Goat kidneys were exposed to HIFU (control group) or microbubble-assisted HIFU (experimental group). Microbubbles were intravenously injected before focused ultrasound exposure. The linear scan was employed and tissue ablation was performed in manner of a clinical regime. The necrosis rate was determined 24 h after HIFU. Pathological examinations were performed to confirm tissue necrosis and to determine whether there were unaffected tissues within the exposed volume. Results  The necrosis rate was increased in experimental group (4.17 ± 1.33 vs. 9.32 ± 2.27 mm³/s, P = 0.0007). Ablated tissues formed a hemorrhagic volume on gross examinations, and the boundary between treated and untreated areas was sharp. There was no intact tissue within the exposed volume. Hemorrhage frequently occurred in insonated parenchymas. Destructed ghost cells just inside the demarcation were full of vacuoles, when introducing microbubbles. In control group, the volumes of ablated tissues varied drastically between animals despite a same treatment template. Conclusion  Microbubbles increased the ablation efficiency of HIFU against kidney tissues. A preoperative regime might poorly predict the therapeutic outcome. T. Yu and D. Hu contributed equally to this paper.     

超声造影评价高强度聚焦超声治疗局限性前列腺癌早期疗效的临床研究

目的 探讨超声造影对高强度聚焦超声（HIFU）治疗局限性前列腺癌早期疗效评价的应用价值.方法 采用HIFU-2001型高强度聚焦超声肿瘤治疗系统,对17例局限性前列腺癌进行治疗.治疗前及治疗后1个月分别行超声造影检查,观察瘤体内部及周边组织血流灌注信号特点,据此判定疗效.同时根据直肠指检、经直肠前列腺B超检查前列腺肿块大小、血清PSA等结果进行客观疗效判定.将两疗效判定结果进行对比分析.结果 HIFU治疗前,所有前列腺低回声结节均呈快速高增强.HIFU治疗后,超声造影显示治疗有效15例,其中无增强12例、少量低增强3例;无效2例,仍表现为快速高增强.客观疗效判定有效15例,血清PSA下降幅度均≥50%,其中2例前列腺结节体积缩小≥50%;无效2例,血清PSA、前列腺低回声结节大小体积均与治疗前水平相当.客观疗效判定结果与超声造影结果相符.结论 超声造影能准确显示HIFU治疗局限性前列腺癌的消融范围及程度,是评价早期治疗效果的可靠方法.     

Preliminary Experience Using High Intensity Focused Ultrasound for the Treatment of Patients With Advanced Stage Renal Malignancy

PurposeWe present the preliminary results of patients with advanced stage renal malignancy treated with high intensity focused ultrasound (HIFU), and investigate the safety and feasibility of using HIFU in the treatment of selected patients with renal tumors.Materials and MethodsHIFU treatment was performed in 12 patients with advanced stage renal cell carcinoma and 1 patient with colon cancer metastasized to kidney. Patients were followed after treatment to observe complications and long-term therapeutic efficacy. Complications and changes in symptoms seen at presentation were recorded. Mid stream urine specimens were sent for microscopy and serum creatinine was measured postoperatively. Followup radiological examinations were performed to detect tumor response to the ablation.ResultsA total of 13 patients received HIFU treatment safely, including 10 who had partial ablation and 3 who had complete tumor ablation. After HIFU hematuria disappeared in 7 of 8 patients and flank pain of presumed malignant origin disappeared in 9 of 10 patients. Postoperative images showed decrease in or absence of tumor blood supply in the treated region and significant shrinkage of the ablated tumor. Of the 13 patients 7 died (median survival 14.1 months, range 2 to 27) and 6 were still alive with median followup of 18.5 months (range 10 to 27).ConclusionsThis preliminary experience suggests that HIFU could be safe and feasible in the treatment of patients with advanced renal malignancy.