高强度聚焦超声治疗子宫肌瘤疗效研究

目的探讨高强度聚焦超声治疗子宫肌瘤的有效性,评价超声造影对HIFU治疗的疗效判断。方法选择HIFU治疗的子宫肌瘤患者88例,共检出肌瘤138枚,于治疗前和治疗后彩色多普勒血流显像及超声造影检查,观察瘤体大小、内部及周边组织回声和血流灌注对比变化。结果治疗2~5d后肌瘤内部回声不均匀性增强,血流信号减少,肌瘤内无造影剂显示,肌瘤内时间强度曲线幅度减低。治疗3个月后肌瘤缩小,平均有效率52%,肌瘤内部回声均发生变化,血流信号消失,临床症状改善。结论HIFU治疗子宫肌瘤有效。超声造影可早期客观评估子宫肌瘤血流灌注状态,有效评价HIFU治疗的效果,作为治疗后判断疗效是一项较好的检测指标。     

超声造影评价高强度聚焦超声治疗子宫腺肌瘤的疗效

目的探讨超声造影在高强度聚焦超声（HIFU）治疗子宫腺肌瘤疗效评价中的应用价值。方法选择痛经症状明显,经临床、超声检查诊断为子宫腺肌瘤,不愿接受手术治疗的已生育患者20例,在二维超声定位及实时监控下应用HIFU进行治疗。于HIFU治疗前1周、治疗后1、3及6个月采用常规二维超声、彩色多普勒超声及超声造影观察腺肌瘤大小、内部回声、血流变化及超声造影图像改变。结果HIFU治疗后3个月及6个月,20个子宫腺肌瘤体积逐渐缩小,所有瘤体内部回声增强、彩色血流均消失。超声造影显示18个腺肌瘤内造影剂持续无灌注,2个瘤体内部呈网格状少许灌注。结论超声造影是HIFU治疗子宫腺肌瘤疗效评价的有效方法。     

高强度聚焦超声治疗子宫肌瘤和子宫腺肌瘤的临床应用

目的 探讨高强度聚焦超声(HIFU)应用于临床治疗子宫肌瘤和子宫腺肌瘤的效果和安全性.方法 以子宫肌瘤和子宫腺肌瘤患者为研究对象,采用HIFUNIT-9000型超声聚焦肿瘤消融机实施治疗.观察治疗前后患者临床症状和瘤体超声回声、血流及大小的变化.结果 共治疗子宫肌瘤和子宫腺肌瘤患者116例,治疗瘤体共192个,其中肌瘤166个,腺肌瘤26个.治疗后82例患者各种症状得到改善;瘤体缩小,瘤体超声回声增强,血流减少.治疗效果总有效率94.2%,其中显效率53.8%.结论 HIFU治疗子宫肌瘤和子宫腺肌瘤效果明显,无创、安全.     

高强度聚焦超声治疗子宫肌瘤40例近期疗效分析

目的 探讨高强度聚焦超声(HIFU)治疗子宫肌瘤的近期疗效.方法 HIFU治疗子宫肌瘤患者40例.术后6个月分别进行超声、彩色多普勒血流显像、超声造影及MRI监测.观察瘤体大小及血流灌注对比变化.结果 治疗后6个月超声造影、MRI监测肌瘤大小和充盈缺损区无差别.结论 HIFU治疗子宫肌瘤疗效确切,超声造影及MRI监测可以作为评价HIFU治疗子宫肌瘤有效性的客观指标.     

超声造影在子宫肌瘤高强度聚集超声消融治疗术中的应用

目的探讨超声造影在高强度聚焦超声(HIFU)消融治疗子宫肌瘤术中的应用价值。方法 120例子宫肌瘤患者共123个肌瘤进行HIFU消融治疗,应用超声造影定量分析术前、术中及术后子宫肌瘤血供情况,指导治疗参数强度的增减,进而评估HIFU疗效。结果 115个肌瘤术后超声造影表现为中央低回声无强化的消融区,并有窄边强化,治疗前瘤体血流分级分别为Ⅰ级36个,Ⅱ级47个,Ⅲ级32个;治疗后瘤体回声明显增强,血流信号不丰富,血流分级为0级110个,Ⅰ级5个。经术后6个月复查,未见复发肿瘤组织,瘤体体积缩小≥30%,证实显著有效。另有8个消融区边缘有结节或有不规则增厚边缘强化,其中5个经病理学确认有残留存活肿瘤组织,血流分级为Ⅰ级,但瘤体体积缩小30%,3个6个月后复查表现为增大。超声造影实时监测HIFU治疗子宫肌瘤总体有效率为93.5%。结论超声造影能直接显示肿瘤坏死灶的血供情况,实时反映肿瘤组织坏死程度,并可通过肿瘤增强特征对组织消融的范围和能量控制提供有效的影像学依据,在HIFU消融治疗子宫肌瘤的参数设定及增效作用、疗效评价方面有较大的应用价值。     

高强度聚焦超声对子宫平滑肌瘤微血管的破坏作用

目的探讨高强度聚焦超声(HIFU)在治疗子宫平滑肌瘤中对微血管的破坏作用。方法114例患者共175个子宫肌瘤行HIFU治疗,分别于治疗前后1周同时行彩色多普勒血流显像(CDFI)和实时超声造影(CEUS)检查,分析HIFU治疗后瘤体血流灌注情况。其中64个肌瘤术前、术后行超声引导下穿刺活检,用免疫组化法对标本用CD31单克隆抗体进行肿瘤血管内皮染色,计数肿瘤微血管密度(MVD),分析比较HIFU治疗前后MVD变化情况。结果175个子宫肌瘤行HIFU治疗后,CDFI在143个肌瘤内未测及任何血流信号,24个肌瘤血流信号明显减少,8个肌瘤血流信号无明显变化;CEUS在141个肌瘤内显示造影剂完全充盈缺损,13个肌瘤瘤体内大部分组织充盈缺损,周边有局灶性增强,21个肌瘤显示为造影剂弥漫增强。术前64例活检组织免疫组化染色MVD计数平均为60.3±17.0;术后显示微血管大量破坏,64例组织MVD计数平均12.1±16.3,术前、术后MVD比较差异有统计学意义(P<0.001)。结论HIFU能从体外破坏肿瘤血管,加强了HIFU杀死子宫平滑肌瘤细胞的直接效应。     

超声造影评价高强度聚焦超声消融治疗子宫肌瘤疗效的初步应用

目的探讨超声造影评价高强度聚焦超声治疗子宫肌瘤疗效的有效性。方法11例子宫肌瘤患者(12个病灶)分别在高强度聚焦超声治疗前3天、治疗后1个月、3个月及6个月采用常规二维超声、彩色多普勒超声及超声造影观察肌瘤大小、血流及造影改变。结果子宫肌瘤治疗后体积缩小明显,治疗后1个月、3个月及6个月体积缩小率分别为39．21±19．68%、55．58±25．69％、74．15±29．66％(P<0．05);肌瘤内部及周边的血流消失或基本消失:时间-强度曲线显示正常子宫肌层治疗前后造影剂灌注未见明显改变, 11个病灶治疗后呈持续造影剂无灌注或低灌注状态,余1个病灶边缘动脉期有小片状造影剂灌注。所有患者治疗后临床症状改善明显,少有并发症发生。结论超声造影是评价高强度聚焦超声治疗子宫肌瘤疗效的一种有效、简便的方法。     

高强度聚焦超声治疗子宫肌瘤的临床探讨

【目的】探讨高强度聚焦超声（high intensity focused ultrasound,HIFU）治疗子宫肌瘤的安全性和有效性。【方法】选择12例已生育的、不愿手术、要求保留子宫的子宫肌瘤患者,观察HIFU治疗前后肌瘤的超声回声、血流、大小及临床症状变化。【结果】治疗后肌瘤内部回声增强,血流信号减少,肌瘤缩小,临床症状改善,无严重副作用。【结论】HIFU治疗子宫肌瘤安全、有效,值得进一步研究、观察。     

高强度聚焦超声治疗子宫肌瘤及彩色多普勒能量图判断疗效

目的 探讨高强度聚焦超声(high intensity focused ultrasound HIFU)治疗子宫肌瘤的安全性和有效性，评价彩色多普勒能量图(CDE)对HIFU治疗的疗效判断。方法 选择86例子宫肌瘤患，观察HIFU治疗前后肌瘤的超声回声、肌瘤大小及临床症状变化，用CDE对治疗前后肌瘤内部血流灌注对比观察。结果 治疗后肌瘤内部回声增强，血流信号减少，肌瘤缩小，临床症状改善，无严重副作用。结论 HIFU治疗子宫肌瘤安全、有效。CDE可客观评估子宫肌瘤血流灌注状态，有效评价HIFU治疗的疗效，作为治疗后疗效判断是一项较好的检测指标。     

彩色多普勒超声对高强度聚焦超声治疗子宫肌瘤及腺肌瘤的疗效观察

目的 探讨彩色多普勒超声显像(color Doppler flow imaging,CDFI)对高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗子宫(腺)肌瘤的近期疗效及其实用性.方法 选择86例临床确诊的子宫(腺)肌瘤患者行HIFU治疗,应用CDFI观察比较治疗前后瘤体大小、回声、血流动力学等不同的改变.结果 86例子宫(腺)肌瘤HIFU治疗后1～6个月CDFI复查和随访,瘤体明显缩小者49例,无明显改变者30例,有增大趋势7例;瘤体内回声明显增强71例,无明显改变15例,边界趋于清晰69例;血流信号消失53例,血流信号减少18例,血流信号无明显改变15例;月经期经量明显减少,临床症状明显改善者66例.HIFU治疗子宫(腺)肌瘤总有效率为82.56%(71/86).结论 HIFU治疗子宫肌瘤近期疗效确切,CDFI可用于HIFU疗效的观察及评价.     

超声波与声学造影剂在溶栓中的作用

血栓形成是导致心肌梗塞、缺血性卒中等疾病和死亡的重要原因。超声波和声学造影剂（微泡）可通过空化效应、机械作用等多种生物学效应直接溶栓和增强溶栓药物作用。在微泡的介导下,其潜在的携药载体作用和靶向结合能力为进一步提高溶栓效率提供了可能,该方法有着广阔的临床应用前景。     

Quantitative ultrasound for the monitoring of novel microbubble and ultrasound radiosensitization

There is a need for cancer imaging to provide "real-time" information about the metabolic and cellular responses of tumours. Quantitative ultrasound techniques have recently been demonstrated to be a potential method of assessing tumour response at the cellular level. Anti-cancer treatments administered to xenograft-bearing mice consisted of radiotherapy and a novel antivascular therapy utilizing encapsulated microbubble agents in the presence of ultrasound. Radiation dose and microbubble concentrations were varied and the treatment modalities were given in combination to assess the possible enhancement of tumour cell death. Quantitative methods were used to non-invasively assess responses. Results demonstrated statistically significant changes in backscatter parameters (midband fit, spectral intercept) in tumours treated with high doses of radiotherapy or a high concentration of microbubbles. Combined treatments demonstrated further increases in ultrasound parameters. Histopathologic assessment was used and tumour cell death was found to correlate with increases in ultrasound parameters.     

Doppler ultrasound of the kidney

Conventional ultrasound of the kidney is used commonly to depict structural abnormalities. It is limited, however, by a lack of functional and vascular information. Doppler sonography can reduce this limitation of standard sonography quickly and noninvasively. Doppler examinations, although not difficult, must be done properly to obtain useful data. Information regarding the presence and direction of flow in renal vessels can be obtained. Vascular stenosis can be identified by several Doppler criteria, although the role of Doppler as a screening measure remains controversial. Assessment of vascular resistance is possible from Doppler waveform analysis, using parameters such as the resistive index. These data may provide hemodynamic and predictive information regarding a dilated collecting system identified by conventional ultrasound. Analysis of the resistive index also may provide helpful clinical information in nonobstructive renal disease. In certain clinical settings, such analysis provides diagnostic data not readily available with other clinical and laboratory assessment methods. Pharmacologically stimulated renal Doppler examinations may lead to even greater benefits in the future. This article reviews renal Doppler ultrasound, including the physiological basis for Doppler examination, the technical principles of renal Doppler sonography, and the clinical applications of Doppler findings.     

Intraoperative ultrasound of the kidney

Intraoperative ultrasound is a useful method of identifying renal masses during partial nephrectomy. It can be used to locate primary lesions, identify satellite lesions, assess for peritumoral vascularity and venous invasion. As nephron-sparing surgery becomes more widespread, intraoperative ultrasound of the kidneys will become more commonplace.     

Endoscopic ultrasound and intraductal ultrasound in the diagnosis of small pancreatic tumors

Background: The purpose of this study was to assess the diagnostic value of endoscopic ultrasound (EUS) and intraductal ultrasound (IDUS) in the detection of small pancreatic tumors. Methods: EUS was performed in 166 patients with verified pancreatic disease. IDUS was performed in 46 patients. A microprobe was introduced into the main pancreatic duct through the papilla of Vater using the duodenoscope. Results: EUS was valuable in the detection of small pancreatic tumors. Ductal adenocarcinomas smaller than 1 cm were demonstrated as a hypoechoic mass with a central irregular hyperechoic area. EUS and IDUS were useful in the characterization of intraductal paillary tumors (ductectatic mucinous tumors). EUS demonstrated nodular excrescences, and IDUS depicted papillary proliferation of the duct epithelium, which are characteristic of carcinomas and adenomas but not of hyperplasia. Internal architecture of cystic neoplasms was clearly depicted by EUS, and differentiation of serous and mucinous tumors was readily achieved. A tumor as small as a 5-mm islet cell was demonstrated on EUS because islet cell tumors are very hypoechoic. Conclusion: EUS and IDUS are relatively noninvasive procedures and are useful in the detection of small tumors and differentiation of pancreatic diseases. Received: 0/0/0/Accepted: 0/0/0     

经腹部超声联合经阴道超声检查诊断妇产科急腹症

目的：探讨经腹部超声联合经阴道超声检查在妇产科急腹症诊断中的价值。方法：选择2013年1月～2016年6月经本院临床及病理确诊的妇产科急腹症患者110例为对象,所有患者均采用经腹部超声联合经阴道超声检查,比较超声检查诊断结果与临床病理诊断结果的符合率,并分析各类急腹症的超声影像表现。结果：经腹部超声联合经阴道超声检查诊断妇产科急腹症的符合率97.27%(107/110),与临床病理结果比较差异无统计学意义(P＞0.05);诊断异位妊娠的符合率96.77%(30/31),诊断宫内孕流产的符合率94.44%(17/18),诊断卵巢囊肿破裂的符合率93.33%(14/15),诊断急性盆腔炎、卵巢肿瘤蒂扭转、子宫内膜异位症、胎盘早剥的符合率均为100%(23/23、10/10、8/8、5/5),与临床病理结果比较差异无统计学意义(P＞0.05)。结论：经腹部超声联合经阴道超声检查在诊断妇产科急腹症中,与临床病理结果的符合率高,是一种可行的方案。