高强度聚焦超声消融治疗子宫肌瘤时妊娠一例报告并文献复习

高强度聚焦超声(high-intensity focused ultrasound,HIFU)消融治疗子宫肌瘤作为一种新的非侵入性的治疗方式,已越来越广泛地用于子宫肌瘤的治疗。但是对于HIFU治疗时妊娠的处理及妊娠结局鲜有文献报道。本文报道1例HIFU消融治疗子宫肌瘤时妊娠的病例,结合文献复习,探讨子宫平滑肌瘤对妊娠的影响、子宫平滑肌瘤不同处理方式对妊娠的影响、HIFU消融治疗子宫肌瘤时机选择的问题、HIFU消融治疗子宫肌瘤若同时合并妊娠时胎儿去留的问题以及近期HIFU消融治疗子宫肌瘤后对流产手术操作的影响等,以期对HIFU治疗子宫肌瘤的适应证、选择合适的治疗时间及术后选择合适的妊娠时机展开讨论。     

500 Cases of High-intensity Focused Ultrasound (HIFU) Ablated Uterine Fibroids and Adenomyosis

ObjectiveClinical outcomes of 500 high-intensity focused ultrasound (HIFU)-treated uterine fibroids and adenomyosis are analyzed and presented.Materials and methodsThis is a retrospective cross-sectional analysis from a single tertiary medical center. From April 2015 to October 2018, 546 cases were enrolled for the study. After excluding 46 patients with less than 3 months of follow-up period, there were 404 fibroids, 149 adenomyosis and 53 mixed conditions entered for analysis. The patients’ uterine fibroids and adenomyosis were treated by HIFU according to Chongqing Haifu protocol, with 12 cm diameter transducer of focal length 10–16  cm at 0.8 or 1.6 MHz T2-weight MRI imaging was rendered prior to and 3 month post treatment to assess lesion volume change using non-perfusion volume, which was the primary outcome. Secondary outcomes including quality of life, subjective satisfaction, adverse events and pregnancy rate were determined using self-reported questionnaires. The mean follow up period ranged from 3 to 38 months with an average of 21 months.ResultsThree months after HIFU-treated uterine fibroids and adenomyosis, the lesion size reduced 40.2% and 46.3%, respectively. Symptoms all improved with better quality of life for the fibroid group, while those with adenomyosis or combined diseases benefit the most from pain control. Serum CA125 decreased significantly for all studied groups, and LDH only showed improvement for fibroids group. Number of adverse events is comparable to Chongqing data (approximately 10.2%), with mostly mild and self-resolving conditions. No permanent sequelae or death was documented. Twelve pregnancies are reported in this cohort.ConclusionHIFU is safe and effective in treating uterine fibroids and adenomyosis. The results are reproducible if standardized treatment schedules are followed. It is a promising treatment alternative with the advantages of precision, non-invasiveness, rapid recovery and readiness for pregnancy.     

Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer

BACKGROUND: High-intensity focused ultrasound (HIFU) is a minimally invasive technique used in achieve coagulation necrosis. We evaluated biochemical disease-free survival rates, predictors of clinical outcome and morbidity in patients with localized prostate cancer treated with HIFU. METHODS: A total of 181 consecutive patients underwent HIFU with the use of Sonablate (Focus Surgery, Indianapolis, IN, USA). Biochemical recurrence was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel. The median age and pretreatment prostate-specific antigen (PSA) level were 70 years (range 44-88) and 9.76 ng/mL (range 3.39-89.60). A total of 95 patients (52%) were treated with neoadjuvant hormones. The median follow-up period for all patients was 18.0 months (range 4-68). RESULTS: The biochemical disease-free survival rates at 1, 3 and 5 years in all patients were 84%, 80% and 78%, respectively. The biochemical disease-free survival rates at 3 years for patients with pretreatment PSA less than 10 ng/mL, 10.01-20.0 ng/mL and more than 20.0 ng/mL were 94%, 75% and 35%, respectively (P<0.0001). Multivariate analysis identified pretreatment PSA (P<0.0001) as a independent predictor of relapse. CONCLUSION: High-intensity focused ultrasound therapy appears to be a safe and efficacious minimally invasive therapy for patients with localized prostate cancer, especially those with a pretreatment PSA level less than 20 ng/mL.     

高强度聚焦超声及其医学应用

HIFU技术的研究在国内外已掀起了热潮．到目前为止．HIFU技术已得到广泛的实验和临床支持。本文将对HIFU治疗设备的总体结构做一阐述．并讨论其在医学领域中的应用及发展方向。     

聚焦超声治疗慢性宫颈炎500例临床分析

目的 探讨聚焦超声治疗宫颈炎的临床疗效.方法 收治慢性宫颈炎700例,分为聚焦超声治疗组(超生治疗组)500例,微波治疗对照组200例.观察其临床症状、体征及疗效.结果 超声治疗组中、重度宫颈炎的疗效明显高于微波对照组,差异有显著意义(P＜0.05);两种方法治疗后,宫颈修复过程中阴道排液、出血等并发症的发生率,超声治疗组明显低于微波对照组,差异有显著意义(P＜0.05).结论 聚焦超声治疗宫颈炎疗效确切,副作用及并发症少,是目前治疗宫颈炎的一种有效方法.     

高强度聚焦超声致大鼠急性肝损伤后机体炎症反应及乌司他丁的保护效应

目的 探讨高强度聚焦超声(HIFU)所致的大鼠急性肝损伤后血清炎性因子水平的变化及乌司他丁(UTI)对其的保护效应.方法 建立高强度聚焦超声致大鼠急性肝损伤模型,Wistar大鼠24只随机均分为单纯高强度聚焦超声致伤组(H组)、乌司他丁处理组(U组)和空白对照组(D组).在致伤后1、3、6、12和24h分别检测三组血清中白细胞介素-2(IL-2)、白细胞介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)三种炎性细胞因子的含量.结果 与D组比较,H组致伤3h后IL-2和TNF-α开始明显升高,并分别于致伤后6h和12h达到峰值.U组IL-2和TNF-α升高幅度明显低于H组(P<0.01),且于致伤后24h基本恢复正常,而IL-10水平显著高于H组.结论 高强度聚焦超声致大鼠急性肝损伤后大鼠机体发生显著炎症反应,乌司他丁能下调致炎因子水平,并可上调抑炎性因子水平,阻断炎症反应,显示出一定的保护效应,改善预后.     

利用磁共振成像实现肿瘤热疗中实时无创测温的方法

肿瘤热疗特别是高强度聚焦超声（HIFU）技术，已成为一种重要且非常具有前景的肿瘤治疗方法，温度是直接决定热疗效果的重要参数，实时准确的进行深部无创测温是目前制约肿瘤热疗进一步发展的一项关键技术。近来利用磁共振成像（MRI）进行无创测温，正受到越来越多的研究者的重视。本文简述了MRI无创测温的三种方法，比较了不同测温原理的特点和适用条件，报道了已有研究发展状况，并介绍了尚待解决的问题。     

高强度聚焦超声的原理和设备及临床应用

高强度聚焦超声(HIFU)是将超声的能量聚集在很小的区域内,通过高热量灼烧病变组织细胞,但不会对周围其他组织产生影响,因此,其被广泛应用于对肿瘤、大脑疾病和血管疾病的治疗中。现阶段,临床正尝试将磁共振引导的HIFU应用于神经外科手术治疗中,如治疗特发性震颤等。该研究简要回顾了HIFU的原理、设备和临床应用,叙述了其在肝脏、乳腺、前列腺、肾脏、子宫肿瘤治疗中的应用效果及应用前景。     

18例大肠癌肝转移高强度聚焦超声治疗的临床观察

目的:研究高强度聚焦超声(HIFU)治疗大肠癌肝转移病灶的安全性和有效性.方法:18例大肠癌术后肝转移患者31个病灶行HIFU治疗,观察患者生命体征、主要脏器功能、影像学检查(CT或MRI等)、并发症和肿瘤转归的情况.结果:所有患者生命体征平稳,肝、肾功能正常,平均随访16.1个月(6～38个月),失访2例,生存13例,12、18个月生存率分别为83.3%和66.7%,中位生存期16个月;随访25个病灶中,17个肿瘤块缩小超过50%,有5例出现新的转移灶,8例出现皮肤浅Ⅱ度烧伤.结论:HIFU治疗是一种安全、有效和非侵入性治疗大肠癌肝转移病灶的手段.     

高强度聚焦超声治疗肿瘤原理及应用原则

介绍高强度超声聚焦刀(HIFU)治疗肿瘤的原理、实验依据、治疗的特点、适应证和禁忌症、治疗原则等，认为HIFU与其他疗法结合将会在治疗肿瘤上有更大的突破．