高强度聚焦超声对人胰腺癌裸鼠移植瘤差异性表达基因的影响

目的 研究高强度聚焦超声(HIFU)辐照人胰腺癌移植瘤后差异性表达基因,从基因组学初步探讨HIFU的生物学机制.方法 构建人胰腺癌裸鼠YY-1移植瘤模型,HIFU辐照后采用Agilent人类基因表达谱芯片检测差异性表达基因,反转录-聚合酶链反应(RT-PCR)技术验证上调基因HIF1a、SMAD4及下调基因Bcl-xl.结果 与未辐照对照组相比,辐照组表达谱芯片分析发现与胰腺癌相关的差异性基因共65个,其中上调43个,下调22个.基因本体(GO)分析提示显著表达改变的基因富集于细胞核、细胞质部位,并与蛋白结合、金属离子结合、锌离子结合、转录调控、细胞凋亡等功能相关.RT-PCR检测结果与表达谱芯片分析结果一致.结论 HIFU辐照可引起一系列基因调控改变,这些差异性表达基因可能参与调控肿瘤生物学过程.     

高强度聚焦超声治疗晚期胰腺癌疼痛疗效分析

 目的 探讨高强度聚焦超声治疗晚期胰腺癌疼痛的疗效和安全性.方法 对22例晚期胰腺癌行高强度聚焦超声治疗,观察治疗前后的疼痛评分、生活质量评分变化及不良反应.结果 全组疼痛缓解总有效率为85％,其中完全缓解10.00％ (2/20),部分缓解55.00％ (11/20),轻微缓解25.00％ (5/20),无效10.00％(2/20).未发生严重并发症.结论 高强度聚焦超声是一种治疗晚期胰腺癌疼痛的有效方法,具有无创和较高的安全性.     

高强度聚焦超声治疗晚期胰腺癌疼痛20例

目前,癌性疼痛的治疗仍然以药物为主。单一药物止痛用药量大,用药频繁,不良反应多。笔者对42例晚期胰腺癌疼痛患者,分别行单纯药物镇痛和高强度聚焦超声（High intensity focused ultrasound,HIFU）加药物治疗,后者用药量显著减少,药物依赖性产生的时间明显延长,为癌性疼痛镇痛治疗探索出一种新方法。     

高强度聚焦超声治疗胰腺癌患者苏醒延迟1例

1病例报告患者女,75岁。诊断为胰腺癌,行高强度聚焦超声(HIFU)治疗。患者8:30入手术室血压(BP)150/90mmHg,心率(HR)70/min,血氧饱和度(SO2)0.96。给予地塞米松10mg、东莨菪碱0.3mg静脉注射,麻醉诱导采用咪达唑仑0.05mg/kg、芬太尼/、丙泊酚/、罗库溴铵/。肌松     

吉西他滨联合高强度聚焦超声治疗晚期胰腺癌疗效观察

目的:观察吉西他滨联合高强度聚焦超声(HIFU)治疗晚期胰腺癌的近期疗效和安全性。方法:选择晚期胰腺癌50例,分为观察组23例和对照组27例。对照组采用静脉滴注吉西他滨治疗;观察组在对照组基础上增加HIFU治疗,比较两组近期疗效和不良反应等。结果:观察组完全缓解(CR)17.4%、部分缓解(PR)30.4%,稳定(SD)30.4%,进展(PD)21.7%;对照组CR 3.7%,PR18.5%,SD 37.0%,PD 40.7%。观察组CR率、PR率显著高于对照组(P<0.05)。观察组临床受益反应(CBR)56.5%,对照组25.9%;两组比较,差异显著(P<0.05)。治疗后,观察组疼痛强度评分非常显著低于对照组(P<0.01)。观察组无脏器穿孔、大出血、腹膜炎等并发症发生。结论:吉西他滨联合HIFU治疗晚期胰腺癌疗效较好,且安全。     

高强度超声聚焦刀治疗晚期胰腺癌疼痛

目的：探讨高强度超声聚焦刀对于晚期胰腺癌疼痛治疗的价值。方法：应用超声聚焦刀治疗晚期胰腺癌37例，用11点数字评分法（NRS-11）评价比较治疗前后患者的疼痛情况。结果：治疗后患者的NRS-11明显较治疗前降低（P〈0．05）。结论：超声聚焦刀对晚期胰腺癌患者，在改善生活质量、缓解疼痛方面作用显著。     

高强度聚焦超声治疗肝癌研究进展

原发性肝癌(HCO)首选手术治疗,但许多病例在被发现时已失去了手术机会。对此,主要采取介入治疗,如选择性肝动脉栓塞化疗(TACE)、B超引导下经皮肝癌无水乙醇注射(PEIT)等,上述疗法虽能取得一定疗效,但多为侵袭性手段,亦有一定局限性。近10余年来,随着超声治疗学的飞速发展,新兴起的高强度聚焦超声(high intensity focused ultrasound,HIFU)作为一种无创性非手术疗法,在实验研究和临床应用方面取得了一定进展。     

高强度聚焦超声治疗肘关节区复发性神经纤维瘤1例

1 病例报告患者女性,45岁,发现左上臂肿物10年,术后局部复发伴疼痛、肿胀并进行性加重11个月,于2007年3月12日入我院.入院查体:左上臂下段外侧可见一长约20 cm的弧行手术疤痕,愈合良好,疤痕上方可触及一约10 cm×8.5 cm的肿物,质硬、固定、轻度压痛,局部皮温较高伴肿胀明显,沿手术疤痕中点测量上臂周径为31 cm,上方1 cm处周径为32 cm.左前臂近肘关节处轻度肿胀,疤痕下方可及一直径约3 cm的肿物,性质相同.左肘关节被动屈曲位,最大伸展度为135°,活动显著受限.其他神经系统查体未见显著异常.局部超声及CT、MRI等检查均提示:左肘关节外上、下方富血供不规则占位.原手术病理切片经我院及解放军总医院会诊,均认为是神经纤维瘤.入院诊断结果:左上肢神经纤维瘤,术后复发.     

高强度聚焦超声治疗子宫肌瘤疗效观察

目的：观察高强度聚焦超声（HIFU）治疗子宫肌瘤的疗效。方法：选择子宫肌瘤160例,采用HIFU治疗,比较治疗后3个月与治疗后6个月在月经量、贫血症状及瘤体大小、病灶回声、病灶血供方面的变化情况。结果：在月经量减少、贫血症状改善、瘤体缩小、病灶回声增强和病灶血供减少方面,治疗后6个月的总有效率均显著高于治疗后3个月（P〈0.05）。结论：HIFU治疗子宫肌瘤疗效较好,且在治疗后6个月疗效更为显著。     

动脉灌注化疗联合高强度聚焦超声治疗胰腺癌的临床研究

目的 评价动脉灌注化疗联合高强度聚焦超声治疗胰腺癌的临床价值.方法 将64例不能手术切除的胰腺癌患者随机分成2组,研究组32例采用动脉灌注化疗联合高强度聚焦超声方案;对照组32例采用动脉灌注化疗方案.观察两组方案的有效率、临床收益率、不良反应和生存期.结果 两组近期有效率(PR + MR)分别为55.56%和28.57...     

高强度聚焦超声治疗子宫腺肌病临床研究进展

高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗为近年来兴起的一项无创技术,因其安全、无创、无辐射、可重复等优点,广泛应用于各种实体肿瘤的治疗。本文对HIFU治疗子宫腺肌病的作用机制、适应证、禁忌证、治疗方法、安全性及有效性和并发症进行综述。     

Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: Preliminary results

Purpose

To evaluate the safety and therapeutic efficacy of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) ablation for the treatment of abdominal wall endometriosis (AWE).

Materials and methods

Twenty-one consecutive patients with AWE were treated as outpatients by US-guided HIFU ablation under conscious sedation. The median size of the AWE was 2.4 cm (range 1.0-5.3 cm). An acoustic power of 200-420 W was used, intermittent HIFU exposure of 1 s was applied. Treatment was considered complete when the entire nodule and its nearby 1 cm margin become hyperechoic on US. Pain relief after HIFU ablation was observed and the treated nodule received serial US examinations during follow-up.

Results

All AWE was successfully ablated after one session of HIFU ablation, the ablation time lasted for 5-48 min (median 13 min), no major complications occurred. The cyclic pain disappeared in all patients during a mean follow-up of 18.7 months (range 3-31 months). The treated nodules gradually shank over time, 16 nodules became unnoticeable on US during follow-up.

Conclusion

US-guided HIFU ablation appears to be safe and effective for the treatment of AWE.     

MRI methods for the evaluation of high intensity focused ultrasound tumor treatment: Current status and future needs

Thermal ablation with high intensity focused ultrasound (HIFU) is an emerging noninvasive technique for the treatment of solid tumors. HIFU treatment of malignant tumors requires accurate treatment planning, monitoring and evaluation, which can be facilitated by performing the procedure in an MR‐guided HIFU system. The MR‐based evaluation of HIFU treatment is most often restricted to contrast‐enhanced T₁‐weighted imaging, while it has been shown that the non‐perfused volume may not reflect the extent of nonviable tumor tissue after HIFU treatment. There are multiple studies in which more advanced MRI methods were assessed for their suitability for the evaluation of HIFU treatment. While several of these methods seem promising regarding their sensitivity to HIFU‐induced tissue changes, there is still ample room for improvement of MRI protocols for HIFU treatment evaluation. In this review article, we describe the major acute and delayed effects of HIFU treatment. For each effect, the MRI methods that have been—or could be—used to detect the associated tissue changes are described. In addition, the potential value of multiparametric MRI for the evaluation of HIFU treatment is discussed. The review ends with a discussion on future directions for the MRI‐based evaluation of HIFU treatment. Magn Reson Med 75:302–317, 2016. © 2015 Wiley Periodicals, Inc.     

肋骨和肺组织阻挡对高强度聚焦超声破坏犬肝组织的影响

目的 :探讨肋骨和肺组织阻挡对高强度聚焦超声 (high intensityfocusedultrasound ,HIFU)破坏犬肝组织的影响。方法 :2 0条实验犬随机平均分为对照组和手术组 ,手术组模拟行肋骨部分切除、肋膈角闭合术 (partialcostectomyandcostophrenicangleclosure,PCCAC) ;以 0 .8MHz、焦距 12 0mm、定点点打、声功率 2 2 0W连续照射两组实验犬肝右叶 90s ,对肝毁损灶进行面积和体积测定及病理学检查。结果 :超声显示手术组犬肝形成 (1.0 4± 0 .2 3)cm2 回声增强区 ,对照组没有观察到回声增强区 ;肉眼下实验犬肝毁损灶体积 (3.2 4± 0 .4 7)cm3 ,与对照组具有显著性差异 (P<0 .0 5 ) ;对毁损灶的HE染色证实手术组犬肝毁损灶的坏死程度明显增强 ,范围增大。结论 :肋骨和含气肺组织的遮挡对HIFU破坏犬肝组织具有明显的负影响 ,行PCCAC后可以有效提高HIFU在肝脏治疗靶区内的有效能量 ,减少衰减     

Ultrasound- and MR-guided focused ultrasound surgery for prostate cancer

Prostate cancer(PC) is one of the most frequently diagnosed cancers in men.There are a number of treatment options for PC with a different therapeutic approach between USA and Europe.Radical prostatectomy is one of the most used therapies but focal gland therapy is an emerging approach,especially for localized tumors.In this scenario,high intensity focused ultrasound(HIFU) has been incorporated in certain medical association guidelines.HIFU has been employed for about 10 years especially for localized PC.Results are promising with a 5-year biochemical survival rate ranging from 45% to 84%.Collateral events are rare and HIFU retreatment is not common.Magnetic resonance guided focused ultrasound surgery(MRgFUS) was recently presented as a method for ablation with focused ultrasound under magnetic resonance imaging guidance.It has the advantage of improved targeting and real time temperature monitoring but only a few studies have been conducted with human patients.The aim of this review is to describe the current status of HIFU and MRgFUS in the therapy of PC.     

聚焦超声治疗外阴白色病变临床研究

目的 研究聚焦超声治疗外阴白色病变的可行性。方法 对65例外阴白色病变患者实施了聚焦超声治疗。与此同时,对每一例患者进行严密随访与定期复查。观察治疗前后不同时期病变组织的病理变化(皮肤的颜色及弹性是否恢复正常,粘连是否得到松解),患者的主观感受(瘙痒、灼痛等其他不适症状是否减轻或消失),并对并发症进行治疗、处理。结果 所有患者的病变都得到了不同程度的缓解与恢复,有效率达100％。其中28例痊愈(43．08％),29例显效(44．62％),8例好转(12．46％)。5例患者于治疗后2～3个月局部小范围病灶复发,再次治疗后依然有效。结论 聚焦超声是当前治疗外阴白色病变的一种行之有效的新方法,该方法不仅能够彻底根除外阴顽固性瘙痒等症状,还可恢复外阴皮肤的颜色与弹性,值得在临床上进一步推广应用。     

Proton resonance frequency shift-weighted imaging for monitoring MR-guided high-intensity focused ultrasound transmissions

Purpose:

To combine temperature‐related information of phase images and magnitude images acquired from an MR spoiled gradient echo sequence using a postprocessing method referred to as PRF‐shift‐weighted imaging (PRFSWI).

Materials and Methods:

Phase images are capable of detecting shifts in proton resonance frequency (PRF) caused by local changes in temperature. Magnitude images provide anatomical information for treatment planning and positioning as well as temperature‐related contrast. We used PRFSWI to produce a phase‐mask and performed multiplication on the magnitude image to increase temperature‐related contrast.

Results:

Through MRI‐guided focused ultrasound (MRIgFUS) experiments (both ex vivo and in vivo), we determined that PRFSWI is capable of enhancing the contrast of a heated area even in the initial stages of transmitting high‐intensity focused ultrasound energy.

Conclusion:

The PRFSWI images are sensitive to changes in temperature and display the heated spot directly in the magnitude images. Although the images do not provide quantitative data related to temperature, this method could be used as a complement to the phase temperature mapping method in the real‐time monitoring of MRIgFUS experiments. J. Magn. Reson. Imaging 2011;33:1474–1481. © 2011 Wiley‐Liss, Inc.     

高强度聚焦超声补救治疗TACE失败肝癌的临床应用

目的 评价高强度聚焦超声(HIFU)补救性治疗经选择性肝动脉化疗栓塞(TACE)失败的晚期肝细胞肝癌(HCC)患者的有效性和安全性.方法 回顾性分析44例应用HIFU治疗的经TACE治疗失败的晚期HCC患者临床资料.结果 患者总生存时间为12.8个月(95％CI:10.4 ～ 15.0),1年生存率为46.7％,2年生存率为11.4％.单因素分析显示,肿瘤分期(P=0.001)、肿瘤大小(P＜ 0.001)、门静脉癌栓(P=0.030)、AFP水平(P=0.001)和消融效果(P＜ 0.001)为预后的影响因素.多因素分析显示肿瘤大小(P=0.002)及临床分期(P=0.010)是影响患者总生存时间的独立预测因素.3/4级不良反应包括发热(4.5％)贫血(4.5％)、腹部不适(4.5％)、皮肤烧伤(9.1％)、乏力(4.5％)、出血(2.3％)等,未出现严重并发症.结论 对于TACE治疗失败的HCC患者,应用HIFU可有效降低肿瘤负荷,延长生存时间.