恶性骨肿瘤的高强度聚焦超声无创治疗

目的 探讨以高强度聚焦超声为主无创治疗恶性骨肿瘤的疗效、可能并发症和禁忌证。方法 以HIFU为主无创治疗20例恶性骨肿瘤患者，观察治疗前后临床表现、生化指标、影像学、组织病理学、肢体功能评价等方面变化及并发症。结果 临床表现、肢体功能评价等改善，生化指标、影像学、组织病理学明显地显示为HIFU治疗后的改变，效果满意，且并发症轻微。结论 HIFU治疗恶性骨肿瘤是安全有效、便捷可行的，慎重选择适合的病例可避免或减少并发症的发生。     

高强度聚焦超声和射频消融治疗子宫腺肌瘤的临床对比研究

目的:对比分析高强度聚焦超声（HIFU）和射频消融（RFA）两种方法治疗子宫腺肌瘤患者的临床疗效。方法:回顾性分析2014年3月至2016年3月于我院就诊的250例子宫腺肌瘤患者临床资料,其中接受HIFU治疗患者136例、RFA 治疗患者114例。根据子宫腺肌瘤直径将患者分为3组（2~4 cm组、＞4~6 cm组、＞6~8 cm组）,对比两种治疗方法的疗效及并发症。结果:HIFU及RFA组间患者一般情况比较及2~4 cm、＞4~6 cm、＞6~8 cm腺肌瘤组内两组间病例数分布、年龄、不同位置肌瘤构成比比较无统计学差异（P>0.05）,两种治疗组总有效率分别为83.09%、93.86%,两组比较差异有统计学意义（P＜0.05）。对于2~4 cm的子宫腺肌瘤患者,HIFU及RFA治疗组总有效率比较差异无统计学意义（P>0.05）。对于＞4~6 cm、＞6~8 cm的子宫腺肌瘤患者,HIFU及RFA治疗组总有效率比较差异均有统计学意义（P＜0.05）,RFA治疗组总有效率明显高于HIFU治疗组。HIFU治疗组并发症发生率显著低于RFA治疗组,差异具有统计学意义（P＜0.05）。结论:对于直径小于4 cm的子宫腺肌瘤患者建议选择HIFU,因其疗效与RFA相当,但并发症发生率低;而对于大于4 cm的子宫腺肌瘤,建议选择RFA治疗。两种治疗方法对于子宫腺肌瘤患者来说均是有效的治疗方法,值得临床推广。     

高强度聚焦超声治疗乳腺癌

目的：观察高强度聚焦超声(HIFU)体外治疗乳腺癌的临床安全性和有效性，并初步筛选判断治疗效果的检查手段。方法：24例乳腺癌患者在行乳腺癌改良根治术前1～2周行HIFU治疗，HIFU治疗中和治疗后，监测患者血压、呼吸、脉搏和外周血氧饱和度的变化。同时，观察HIFU对靶区处组织和皮肤的损伤作用、手术切除标本送病理检查．观察HIFU对靶区组织的破坏效应．其中3例患者在HIFU治疗前后行^99mTc-MIBI ECT检查．1例患者在HIFU治疗前后行MRI检查。结果：HIFU治疗对靶区外邻近组织和患者生命体征无明显影响，HIFU靶区内组织呈完全凝固性坏死。^99mTc-MIBI ECT和MRI显示靶区内组织坏死。结论：在实时超声引导下，HIFU治疗安全、有效，^99mTc-MIBI ECT和MRI可作为判断疗效的检查方法，HIFU技术可望成为乳腺癌保乳治疗方法之一．     

高强度聚焦超声消融在胰腺癌治疗中的现状与展望

胰腺癌具有早期侵袭性生长和远处转移的特性,起病隐匿,发现时多属于中晚期,手术切除是胰腺癌唯一可以根治的方法。如何提高手术切除率和生存率一直是胰腺癌临床治疗     

肿瘤超声介入治疗的现状与思考

摘 要：超声介入是现代超声医学的分支,在实时超声引导下,通过穿刺针实现了诊断或治疗的目的。随着超声介入技术的发展,超声介入治疗临床应用广泛,尤其是肿瘤的超声介入治疗,达到了与外科手术相当的治疗效果。文章通过对各种超声介入治疗方法的现状分析,阐述各自的特点及在不同肿瘤治疗中的应用,并对如何更好发展超声介入技术进行思考。     

高强度聚焦超声治疗乳腺癌骨转移的疗效

目的:研究高强度聚焦超声（high intensity focused ultrasound,HIFU）治疗乳腺癌骨转移的疗效。方法:选取乳腺癌骨转移患者50例,随机将患者分为观察组与对照组,每组各25名。观察组采用HIFU治疗,对照组采用放疗。观察2组患者治疗前后的疼痛缓解率及骨显像浓集影区别。结果:观察组与对照组疼痛缓解显效分别为15例（60%）、5例（20%）（P＜0.01）,观察组与对照组治疗前后骨显像CR分别为19例（76%）、1例（4%）（P＜0.01）。结论:HIFU是一种从体外无创治疗骨转移瘤的有效手段。与传统治疗方法相比,治疗时间短,一般需2~3小时,治疗即可完成。局部复发后可再次应用HIFU治疗。HIFU治疗将成为骨转移的又一有效治疗手段。     

中国骨肿瘤热消融治疗专家共识

骨肿瘤是发生在骨骼或其附属组织的肿瘤,包括原发骨肿瘤和转移性骨肿瘤。骨肿瘤治疗手段由原来的开放手术逐渐转变为微创手术,消融治疗是目前骨肿瘤的主要微创治疗方法之一,该治疗手段安全有效。至今国内尚无骨肿瘤热消融治疗共识指导治疗,中国抗癌协会骨肿瘤和骨转移瘤专业委员会组织编写《中国骨肿瘤热消融治疗专家共识》,对热消融的原理、适应证、禁忌证、术前评估、操作流程及并发症处理等问题进行总结归纳,并给出相应推荐,以期对国内医生实施骨肿瘤消融治疗提供帮助与指导。本专家共识为骨肿瘤的热消融治疗仅提供学术性指导意见,具体实施方案需要根据临床实际情况而定。     

超声定位下经皮消融肾肿瘤的临床研究

目的:探索超声定位下微波、射频消融术治疗肾肿瘤的效果,寻找创伤最小并能保留肾单位的治疗肾肿瘤的新手段。方法:选择28例肾肿瘤患者（均为单发,肿瘤直径<4cm),消融治疗前行穿刺活检用来明确肿瘤性质。直径小于2.5cm的肿瘤患者行射频消融,2.5cm≤肿瘤直径<4cm的患者行微波消融治疗。然后对患者术后1月、3月、6月、12月、24月进行超声造影和CT造影复查。结果:所有患者术后均未见严重并发症,术后7天复查未见肿瘤残留,随访期内有2例肾癌患者复发而施行肾癌根治疗术。结论:对于不能耐受手术的肾恶性肿瘤患者,或者不愿意接受手术治疗的肾良性肿瘤患者而言,超声定位下经皮热消融治疗是一种创伤小、恢复快、相对安全的新型有效治疗方案。     

不可切除胰腺癌微无创治疗的研究进展

胰腺癌是一种恶性程度很高的消化系统肿瘤,发病率呈逐年上升趋势,且早期诊断率不高,多数患者确诊时已为不可切除的中晚期,5年总生存率不足10％.近年来,微无创治疗技术快速发展,具有相对安全、高效、创伤小、便捷等优点,在控制胰腺肿瘤进展和缓解疼痛方面疗效显著,患者生活质量和生存期都得到了一定改善.目前应用于胰腺癌的主要微无创...     

Minimally invasive approaches for diagnosis and treatment of early-stage breast cancer

Breast cancer management has been evolving toward minimally invasive approaches. Image-guided percutaneous biopsy techniques provide accurate histologic diagnosis without the need for surgical biopsy. Breast conservation therapy has become the treatment standard for early-stage breast cancer. Sentinel lymph node biopsy is a new procedure that can predict axillary lymph node status without the need of axillary lymph node dissection. The next challenge is to treat primary tumors without surgery. For this purpose, several new minimally invasive procedures, including radiofrequency ablation, interstitial laser ablation, focused ultrasound ablation, and cryotherapy, are currently under development and may offer effective tumor management and provide treatment options that are psychologically and cosmetically more acceptable to the patients than are traditional surgical therapies. In this review, we give an overview of minimally invasive approaches for the diagnostic and therapeutic management of early-stage breast cancer.     

Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis

Purpose: Breast-conserving surgery is effective for breast cancer treatment but is associated with morbidity in particular high re-excision rates. We performed a systematic review and meta-analysis to assess the current evidence for clinical outcomes with minimally invasive ablative techniques in the non-surgical treatment of breast cancer.

Methods: A systematic search of the literature was performed using PubMed and Medline library databases to identify all studies published between 1994 and May 2016. Studies were considered eligible for inclusion if they evaluated the role of ablative techniques in the treatment of breast cancer and included ten patients or more. Studies that failed to fulfil the inclusion criteria were excluded.

Results: We identified 63 studies including 1608 patients whose breast tumours were treated with radiofrequency (RFA), high intensity focussed ultrasound (HIFU), cryo-, laser or microwave ablation. Fifty studies reported on the number of patients with complete ablation as found on histopathology and the highest rate of complete ablation was achieved with RFA (87.1%, 491/564) and microwave ablation (83.2%, 89/107). Short-term complications were most often reported with microwave ablation (14.6%, 21/144). Recurrence was reported in 24 patients (4.2%, 24/570) and most often with laser ablation (10.7%, 11/103). The shortest treatment times were observed with RFA (15.6?±?5.6?min) and the longest with HIFU (101.5?±?46.6?min).

Conclusion: Minimally invasive ablative techniques are able to successfully induce coagulative necrosis in breast cancer with a low side effect profile. Adequately powered and prospectively conducted cohort trials are required to confirm complete pathological ablation in all patients.     

Minimally invasive techniques in breast cancer treatment

Breast conservation therapy has largely replaced mastectomy as the surgical treatment of choice for early-stage breast cancer. As the sentinel lymph node mapping procedure, rather than routine axillary node dissection, becomes the standard of care, the next challenge is how to treat the primary tumor without surgery. Minimally invasive ablation of the primary tumor is possible with a variety of approaches; the goal is to either excise the tumor percutaneously or cool it (with cryotherapy) or heat it (with radiofrequency ablation (RFA), focused ultrasound, or laser interstitial therapy) sufficiently to cause complete cell death. These developing technologies may provide treatment options that are psychologically and cosmetically more acceptable to the patient than traditional therapies, but they need further investigation to prove that they are oncologically sound. This new frontier of surgery without scalpels will require surgeons to develop radiologic expertise and to acquire a basic understanding of molecular biology.     

Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer

Introduction: The aims of the study were to assess the outcome among patients with early breast cancer operated on with wide local excision who developed a subsequent ipsilateral breast tumor recurrence, and to identify risk factors for uncontrolled local disease. Uncontrolled local disease (ULD) was defined as the appearance of clinically manifest invasive adenocarcinoma in the remaining breast or on the ipsilateral chest wall which could not be eradicated with salvage treatment during the period of follow-up (2–18 years). Patients and methods: Eighty-five patients in a cohort of 759 patients, treated for invasive Stage I–II breast cancer with breast-conserving surgery 1976–1985 in Stockholm, with a subsequent ipsilateral breast tumor recurrence (IBTR) were reviewed retrospectively. The majority of the patients were premenopausal (58%), node negative (72%), and had received postoperative radiotherapy (79%). Median follow-up time following breast-conserving surgery was 13 (9–19) years. Multivariate Cox's hazard regression was used in the statistical analysis to identify prognostic factors for ULD. Results: The majority (n = 61) of the IBTR's were located in the original tumor quadrant and showed the same histopathological features as the primary tumor. Salvage mastectomy (n = 65) or reexcision (n = 14) were performed in 79 (93%) of the patients. Twenty-one patients developed ULD. Five years following the diagnosis of IBTR the disease-free survival was 59%, the cumulative incidence for ULD was 24%, and for death in breast cancer 34%. In the cohort of 759 patients, patients who received radiotherapy following the primary breast-conserving surgery had 1% cumulative incidence of ULD following the diagnosis of IBTR compared to 4% among patients that received no postoperative radiotherapy. The cumulative incidence at 5 years of ULD following salvage mastectomy was 12% compared to 33% after salvage reexcision. Patients operated on with breast-conserving surgery with an original tumor size < 15 mm, who were treated with salvage mastectomy for IBTR, had in multivariate analysis the lowest relative risk for ULD. Adjuvant chemotherapy following IBTR treatment did not seem to improve local tumor control. Following the diagnosis of IBTR, 78% (n = 21) of the patients with ULD and/or regional recurrence (n = 27), died of a disseminated breast cancer in contrast to 10% (n = 6) among the remaining 58 patients. Conclusion: Uncontrolled local disease is an important outcome measure following breast-conserving surgery. In this cohort, salvage mastectomy provided a superior local control rate compared to salvage reexcision. A higher although not statistically significant rate of ULD was also seen in patients who had not received postoperative radiotherapy as part of their primary treatment.This revised version was published online in October 2005 with corrections to the Cover Date.