利用B型超声影像评价高强度聚焦超声治疗时超声声窗状况的实验研究

目的观察在高强度聚焦超声(HIFU)实验性损伤猪胰腺组织时超声声窗的B型超声影像表现及不同状况下超声声窗上组织损伤情况,对HIFU治疗前超声声窗进行评价。方法对7头家猪进行了HIFU损伤胰腺的实验,并根据HIFU治疗中超声声窗的B型超声影像表现将声窗状况分为"好、中、差"3级。由于评价为"差"的1头猪出现了明显的声窗组织损伤,故暂不进行HIFU治疗,而先行洗胃、排气后重新评价,直至达到"中"以上再行治疗。HIFU治疗结束后观察超声声窗上各组织器官大体损伤情况及病理表现,与治疗前超声声窗影像学分级进行分析,从而得出适合HIFU治疗的声窗评价标准。结果对评价为"差"的1头猪行HIFU治疗后出现腹壁Ⅲ度组织损伤;评价为"中"的1头猪治疗后也出现了声窗上组织损伤,表现为腹壁Ⅱ度烧伤、胃后壁非穿通性溃疡。其余除治疗结束时腹壁有轻度发热外,未发现明显的声窗组织损伤。在各实验动物中均可见到靶目标胰腺的组织学损伤。结论利用B型超声影像评价HIFU超声通道状况具有重要意义。对声窗状况差不可行HIFU治疗者,可采用一定处理方法待评价为"中"或"好"时再进行,评价为"中"者可能出现非靶目标区的损伤,应谨慎进行治疗。

The assessment of the condition by B-mode ultrasound before high intensity focused ultrasound treatment

Objective To observe the pathway imaging of B-mode ultrasound before HIFU treatment and the injury of the pathway tissue in different conditions to assess the conditions of the HIFU pathway. Methods Seven domestic swine were chosen in the study according to the imaging of the pathway of HIFU and the conditions were graded as 3 levels： good, moderate and poor. In the preliminary experiment 1 swine of poor ultrasound pathway appeared severe damage in abdominal wall. The gastric wall and the conditions of the HIFU pathway were presented with poor quality, therefore the treatment was rearranged after evaluation. After a gastric lavage and deaeration, the condition was reassessed. If the conditions were moderate or good, the treatment could be performed. After HIFU treatment, the injury of the pathway was observed by gross and histology and the analysis was performed to assess the relationship among the injury and the imaging. Results There were obvious injuries in 1 swine with poor and moderate pathway which represented a burn of grade 2- 3 in skin and abdominal wall and a ulcer in the back gastric wall. There was only pyrexia in the other swine and no injury was observed. Histological injury was clear in the pancreas. Conclusions The assessment for the conditions of the pathway of HIFU has great significance. The treatment can only be performed in good ,conditions. The moderate treatments must be cautioned due to an injury of the intended target.