盆腔侵袭性纤维瘤致输尿管狭窄1例报告并文献复习

目的 探讨盆腔侵袭性纤维瘤（AF）的临床特征及诊治方法.方法 报告1例盆腔AF致单侧输尿管狭窄患者的临床资料.结果 手术切除肿块、输尿管下段、部分腹膜及左侧精囊.病理诊断：（盆腔）侵袭性纤维瘤.术后予以放疗,随访3月未见复发.结论 盆腔AF临床罕见,侵犯泌尿系统时易被误诊为泌尿系肿瘤.结合临床表现及影像学特点应考虑到盆腔AF的可能,最终诊断依据病理.治疗采取以手术为主的个体化综合治疗.     

胰腺、空肠和横结肠并发罕见侵袭性纤维瘤病1例报告

正胰腺侵袭性纤维瘤(aggressive fibromatosis,AF)是一种罕见交界性肿瘤,其治疗尚未达成共识。重庆医科大学附属第一院内分泌乳腺外科收治1例胰腺AF病例。现报告如下。1病历简介病人男性,15岁,因"发现上腹部包块1周"于2017-01-03入院。入院1周前病人腹部受击。上腹部扪及一大小约10 cm×7 cm的包块。辅助检查:血清淀粉酶为185.0     

脊柱侵袭性纤维瘤的外科治疗

目的探讨临床上少见的脊柱侵袭性纤维瘤的特点和外科手术联合放射治疗的效果。方法总结1998年1月至2006年9月收治的7例脊柱侵袭性纤维瘤患者,其中颈椎3例、胸椎2例、腰椎2例。所有病例肿瘤均侵犯椎弓根和附件,2例胸椎肿瘤侵犯硬膜囊。7例患者均采用手术治疗,术后进行正规放疗。结果所有患者局部疼痛消失,除1例胸腔镜辅助手术患者拔管后出现包裹性胸腔积液外,其余病例均无围手术期并发症。3例术前神经系统功能障碍者术后神经症状均得到不同程度的改善。术后平均随访17.6（13～23）个月,未见内固定失败和肿瘤复发。结论脊柱侵袭性纤维瘤是一种极为少见的局部侵袭性软组织肿瘤,临床上有侵袭性生长的生物学行为。外科手术切除肿瘤是脊柱侵袭性纤维瘤的主要治疗方法,但因该肿瘤具有较高的复发率,故需联合术后正规化疗才能获得满意的临床治疗效果。     

幼儿小腿侵袭性纤维瘤病一例

正侵袭性纤维瘤病(aggressive fibromatosis,AF)又称韧带样纤维瘤病、硬纤维瘤,是发生于骨骼肌肉系统、缺乏转移能力、具有局部侵袭潜能且复发性高的纤维组织肿瘤,多发生于中青年头颈、腹壁、腹内等部位,发生于幼儿小腿胫前肌群的肢体AF少见。2015年10月我院收治1例右下肢AF患儿,现总结其诊治经验。报告如下。1病例介绍患儿女,1岁1个月。因"出生时发现右小腿肿胀伴     

腹壁硬纤维瘤外科诊治中国专家共识（2023版）

<正>硬纤维瘤(desmoid tumors,DT)是一种罕见的、来源于深部软组织的克隆性肌纤维母细胞增殖性疾病,也称为韧带样纤维瘤病(desmoid fibromatosis,DF)、侵袭性纤维瘤病(aggressive fibromatosis)、深部肌腱膜纤维瘤病等^[1-2]。根据2020年WHO软组织肿瘤分类,DT属于中间型,即局部侵袭型,即使在完全切除后仍具有较高的复发率,但无已知的转移或去分化可能性^[3-4]。     

腹部侵袭性纤维瘤病诊疗进展

目的进一步了解腹部侵袭性纤维瘤（AF）的概念、病理、可能分子机理及诊疗现状,寻找新的肿瘤治疗途径。方法对有关AF的定义、分子机理及临床研究文献进行综述并分析。结果腹部AF是罕见的良性纤维病变,是肌纤维母细胞异常增生的结果;AF的病理特征表明是一种良性疾病,但其具有“恶性”生物学行为,常累及周围脏器和血管而导致死亡。对于有临床症状或并发症的患者,完整切除肿瘤是首选治疗方法。即使手术保证阴性切缘也具有较高复发率,因而其治疗需要多学科综合治疗。结论AF的发生机理极为复杂,其具体机理仍未阐明;目前最有效的治疗手段为手术切除;术后辅助放、化疗及其他治疗的作用尚需进一步研究。     

硬纤维瘤(文献综述)

硬纤维瘤是一种少见的具有局部侵袭性软组织肿瘤,切除不彻底者极易复发,少数甚至致死。兹就其发病情况、可能病因以及治疗注意事项作一介绍。     

高强度聚焦超声治疗前列腺增生和前列腺癌的研究

微创外科是21世纪外科的发展趋势,高强度聚焦超声(HIFU)作为新兴的微创治疗技术,近年来在国内外发展迅速。1994年Bihrle等报道美国应用HIFU治疗前列腺增生(BPH)初步临床经验,1996年Gelet等报道HIFU治疗前列腺癌(PCa)患者早期临床疗效观察。越来越多的临床实践证明,HIFU在治疗BPH和PCa具有很高的安全性和较好的临床效果,并显示出其独特的优势。     

家族性腺瘤性息肉病并发侵袭性纤维瘤病肿瘤离体切除及小肠自体移植1例报告

正家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)是一组以结直肠多发腺瘤为特征的常染色体显性遗传的综合征,FAP大肠内表现主要为结肠腺瘤样息肉,大肠外表现主要为胃小肠腺瘤样息肉、腹壁及肠系膜侵袭性纤维瘤病(aggressive fibromatosis,AF)等~([1])。AF为FAP最常见及病死率最高的肠外相关并发疾病,呈浸润性生长,局部易复发但无远处转移,治疗以手术根治为主~([2])。发生于肠     

高强度聚焦超声治疗外阴上皮内非瘤样病变的随机对照研究

目的评价高强度聚焦超声(HIFU)治疗外阴上皮内非瘤样病变(NNEDV)的疗效与安全性。方法将59例经病理诊断为外阴上皮内非瘤样病变的患者随机分为HIFU组(n=29)和药物组(n=30),分别于治疗前、治疗后1个月和治疗后3个月进行症状、体征和生活质量评分和观察不良反应,比较两组患者的治疗效果和副反应。结果与治疗前相比,治疗后1个月和治疗后3个月两组患者症状和体征评分减少,生活质量评分增加,差异有显著性(P<0.05)。治疗后1个月,HIFU组患者疗效与药物组相比,治疗有效率有显著性差异(P<0.05),HIFU组患者的症状评分改善率与药物组相比,差异有显著性(P<0.05),而体征评分变化两组则无显著性差异(P>0.05)。治疗后3个月,HIFU组疗效与药物组相比,无显著差异(P>0.05),HIFU组未出现阴道周围组织损伤。结论 HIFU与药物治疗外阴上皮内非瘤样病变均具有良好的效果,与药物治疗相比,HIFU治疗具有显效快的特点,是外阴上皮内非瘤样病变治疗的安全有效途径之一。     

Ablation of atrial fibrillation with the Epicor system: a prospective observational trial to evaluate safety and efficacy and predictors of success

Background

High intensity focused ultrasound (HIFU) energy has evolved as a new surgical tool to treat atrial fibrillation (AF). We evaluated safety and efficacy of AF ablation with HIFU and analyzed predictors of success in a prospective clinical study.

Methods

From January 2007 to June 2008, 110 patients with AF and concomitant open heart surgery were enrolled into the study. Main underlying heart diseases were aortic valve disease (50%), ischemic heart disease (48%), and mitral valve disease (18%). AF was paroxysmal in 29%, persistent in 31%, and long standing persistent in 40% of patients, lasting for 1 to 240 months (mean 24 months). Mean left atrial diameter was 50 ± 7 mm. Each patient underwent left atrial ablation with the Epicor system prior to open heart surgery. After surgery, the patients were treated with amiodarone and coumadin for 6 months. Follow-up studies including resting ECG, 24 h Holter ECG, and echocardiography were obtained at 6 and 12 months.

Results

All patients had successful application of the system on the beating heart prior to initiation of extracorporeal circulation. On average, 11 ± 1 ultrasound transducer elements were used to create the box lesion. The hand-held probe for additional linear lesions was employed in 83 cases. No device-related deaths occurred. Postoperative pacemaker insertion was necessary in 4 patients. At 6 months, 62% of patients presented with sinus rhythm. No significant changes were noted at 12 months. Type of AF and a left atrial diameter > 50 mm were predictors for failure of AF ablation.

Conclusion

AF ablation with the Epicor system as a concomitant procedure during open heart surgery is safe and acceptably effective. Our overall conversion rate was lower than in previously published reports, which may be related to the lower proportion of isolated mitral valve disease in our study population. Left atrial size may be useful to determine patients who are most likely to benefit from the procedure.     

High intensity focused ultrasound: The fundamentals,clinical applications and research trends

Diagnostic ultrasound has been clinically used for decades. More recently, high intensity focused ultrasound (HIFU) has been developed for therapeutic use as a non-invasive technique for tissue ablation. HIFU is also being investigated for advanced applications at the cellular level. Under guidance by magnetic resonance or ultrasound imaging, HIFU can achieve precise biological effects in tissue with a high safety profile. In this article, we discuss the basic principles, advantages and limitations of HIFU. We will also address the food and drug administration (FDA) approved clinical applications in the United States and highlight active HIFU research with promising clinical outcomes.     

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。     

Transurethral resection of the prostate immediately after high‐intensity focused ultrasound treatment for prostate cancer

Objectives: To evaluate the long‐term outcomes of transurethral resection of the prostate (TURP) immediately after high‐intensity focused ultrasound (HIFU) treatment for prostate cancer (CaP). Methods: The present retrospective study included 65 CaP patients who underwent HIFU alone and 64 patients who underwent TURP immediately after HIFU. HIFU treatment was carried out using a Sonablate‐500 HIFU device (Focus Surgery, Indianapolis, IN, USA). International Prostate Symptom Score (IPSS) and the occurrence of urinary complications, such as urethral stricture during follow‐up, were statistically compared between groups. Results: Clinical stage tended to be lower for the HIFU + TURP group (P = 0.0311), but none of the preoperative parameters differed significantly between groups. Both catheterization time (P < 0.0001) and post‐treatment IPSS (P < 0.0001) at 6, 12, and 24 months after treatment differed significantly between groups. Urethral strictures were noted in 16 (24.6%) of the HIFU‐only patients and seven (10.9%) of the HIFU + TURP patients. Bladder neck contracture was noted in 11 (68.8%) of the patients with urethral stricture in the HIFU‐only group, but in just two (28.6%) of the patients with urethral stricture in the HIFU + TURP group. Multiple logistic regression analyses showed that TURP resection volume (P = 0.0118) was a strong factor for the prevention of urethral stricture. Conclusions: Our results suggest that combining HIFU with an immediately following TURP improves post‐treatment urinary status without causing additional morbidity.     

Transurethral resection of prostate just following high intensity focused ultrasound in localized prostate cancer--trial for early removal of the urethral catheter

We studied the impact of combined transurethral resection of the prostate (TURP) and high intensity focused ultrasound (HIFU) for localized prostate cancer (CaP) to decrease side effects such as prolonged urinary voiding disturbance observed after HIFU treatment. Included in this study were 18 patients with clinically localized CaP indicated for HIFU just followed by TURP (TUR combination group). Complete response was defined in accordance with ASTRO consensus statement and negative sample in biopsies performed 6 months after the HIFU treatment. Prostate specific antigen (PSA) nadir, International Prostate Symptom Score (IPSS) and morbidity during follow-up of TUR combination group were compared with those of a control of 18 patients who took HIFU treatment alone (HIFU monotherapy group). No statistical significances on the values of preoperative parameters (PSA, prostate volume, Gleason score, and IPSS) between these two groups. The median follow-up duration was 10 (5-15) months in both groups. A statistically significant impact was observed between TUR combination group and HIFU monotherapy group on median catheter time (5 versus 13 days, P<0.0001), PSA nadir (0.096 ng/ml versus 0.430 ng/ml in median, P<0.05) and the evolution of the post-treatment IPSS (8 versus 13.5 in median, P<0.0003) at 3 months after treatment. Urethral stricture necessary for urethral dilation was noted in 1 patient (5.6%) in the TUR combination group while in 2 (11.1%) in the HIFU monotherapy group. CR was obtained in 88.9% in the TUR combination group and 83.3% in the HIFU monotherapy group. Our study suggests that the combination of TURP with HIFU treatment improves posttreatment urinary status without additional morbidity.     

载阿霉素的液-固相变型原位凝胶注射治疗兔VX2肝癌HIFU消融后残癌

目的观察载阿霉素液一固相变型原位注射凝胶（DOX-ISFI）治疗高强度聚焦超声（HIFU）消融兔、,x2肝癌后残癌的疗效。方法以24只兔建立VX2肝癌模型,对肿瘤行HIFU不全消融,随机分为HIFU消融与DOX—ISFI联合治疗组（HIFU＋DOX—ISFI组）、HIFU消融与空白液一固相变原位注射凝胶联合治疗组（HIFU＋N—ISFI组）,每组12只,比较两组肿瘤生长率、PCNA表达情况,并以冰冻切片荧光显像观测药物瘤内分布。结果处理后HIFU＋DOX—ISFI组肿瘤生长明显减慢,其生长率明显低于HIFU＋N—ISFI组（P〈O．05）;HIFU十D0X-ISFI组肿瘤增殖指数明显低于HIFU＋N—ISFI组（P〈0．05）;荧光显像姓示药物从注射中心向剧围呈阶梯状分布。结论DOXISFI能钉效治疗HIFUiVX2肝癌后的残癌。     

高强度聚焦超声在治疗中晚期肝癌中的应用

目的 探讨高强度聚焦超声在治疗中晚期肝癌中的机理及临床意义。方法 运用高强度聚焦超声治疗中晚期肝癌患者并对其术后相关影像学、病理学、免疫学等各项研究现状进行评价。结果 高强度聚焦超声在治疗中晚期肝癌的过程中能产生相应的生理学及物理学特性的改变及其在影像学、组织病理学、免疫学等各方面的相关改变。结论 高强度聚焦超声治疗中晚期肝癌是安全而有效的。     

Role of high-intensity focused ultrasound in treatment of hepatocellular carcinoma

About 70 per cent of patients with hepatocellular carcinoma are diagnosed at intermediate or advanced stages, and most of them are technically unresectable. As a novel, emerging therapeutic modality, high intensity focused ultrasound (HIFU) has a great potential for tumor treatment. In this review, principle of HIFU technique is introduced, and an overview of clinical applications and limitations of HIFU for HCC treatment, as well as prospects for future development, is provided. Consequently, HIFU has been considered a safe and feasible procedure for HCC treatment.     

微泡造影剂用于高强度聚焦超声治疗子宫肌瘤研究进展

作为一种无创热消融技术,高强度聚焦超声(HIFU)越来越广泛地用于治疗子宫肌瘤,疗效肯定。微泡造影剂在病灶识别、HIFU消融后疗效评估及增效方面均具有重要临床价值。本文就微泡造影剂在HIFU治疗子宫肌瘤中的研究进展进行综述。     

High-intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment. This study showed a long‐term follow up of salvage HIFU in men with recurrence of localized prostate cancer following not only external beam radiation therapy but also brachytherapy or proton therapy.

OBJECTIVE

To investigate the use of high‐intensity focused ultrasound (HIFU) as a salvage therapy in patients with recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy.

PATIENTS AND METHODS

We retrospectively reviewed the charts of all patients who had undergone salvage HIFU for biopsy‐proven prostate cancer after primary radiation therapy. Patient characteristics and oncological outcomes were assessed.

RESULTS

Records of 22 patients with a median (range) follow‐up of 24 (5–80) months were reviewed. Patients were men with presumed organ‐confined disease who had been treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high‐dose brachytherapy using In¹⁹²; and one with low‐dose brachytherapy using Au⁹⁸) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52–80) years, with a median (range) prostate‐specific antigen (PSA) level before radiation therapy of 14.3 (5.7–118) ng/mL and a median (range) PSA level of 4.0 (1.2–30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4–96) months. The biochemical disease‐free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low‐, intermediate‐ and high‐risk groups were 100%, 86%, and 14%, respectively. One of the twelve patients who received post‐HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient.

CONCLUSION

Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment.