高强度聚焦超声对香猪正常肝组织辐照时间与损伤范围关系的探讨

Localized lesion to normal miniswine liver with high intensity focused ultrasound and the dose effect relation

目的探讨高强度聚焦超声（ＨＩＦＵ）非侵入性切除肝脏组织的剂量－效应关系及机体反应，旨在为体内深部组织肿瘤的无创性治疗提供实验基础。方法采用重庆医科大学医学超声工程研究所自行设计制造的ＧＬ－１型治疗样机（１．６ＭＨｚ，１３１５３Ｗ／ｃｍ２，３ｓ），对２８只小型香猪肝脏组织进行定位损伤。于处理前１天、处理后１天、７天、１４天、２１天、２８天测定体温、体重，抽血查肝肾功能。ＨＩＦＵ后３天解剖，对肝损伤区进行体积测定和病理学检查。结果在４０ｍｍ深度范围内，ＨＩＦＵ可体外有效地定位损伤肝脏组织。辐照时间与肝组织凝固坏死体积的关系为（１２．５±５．９）ｓ／ｃｍ３。机体反应：体温在处理后１天体温升高２．２９℃，２周内体温升高１℃，２周后恢复正常。体重治疗前后无明显变化。处理前后肝肾功能无明显异常（Ｐ＞０．０５）。副作用：皮肤损伤４例（１４．２８％），３～７天愈合；胃损伤２例（７．１４％），禁食２天，自然进食，生存良好。结论应用高强度聚焦超声非侵入性破坏香猪肝脏组织是有效的，此技术对非侵入性局部破坏人体实体瘤将有重要的临床应用前景。

Objective\ To explore the dose effect relation and organic reaction in the case of in vivo ablation of liver tissues with high intensity focused ultrasound (HIFU) so as to prepare HIFU sonication as a noninvasive in vivo therapy for tumors located in deep seated tissues. Methods\ The GL 1 therapeutic apparatus (1.6 MHz, 13153 W/cm 2, and 3 s duration) developed by the Institute of Ultrasonic Engineering in Medicine of Chongqing Medical University was separately used to selectively destroy the liver tissues of 28 miniswine. Measurement of temperature, body weight, and blood test of hepatic and renal functions were made the day before and after the sonication , and on the 7th, 14th, 21st, and 28th day following the ablation. After 3 days, the autopsy was applied and then the lesions were measured and pathologically examined. Results\ It was observed that HIFU is capable of bringing selective damage to tissues at depth of 40 mm and that the ratio of sonication duration to the volume of coagulative necrosis was (12.5±5.9)s/cm 3. The temperature was 2.29℃ above normal one day after the sonication, 1℃ above normal within two weeks after the sonication, and back to normal again after two weeks. No obvious changes in body weight were observed before and after the treatment. No obvious anomaly of hepatic and renal functions were detected before and after the sonication(P>0.05). Side effects: skin burn 14.28%(4/28), it was recovered within 3 7 days; Gastric impairment 7.14%(2/28), the pigs were not given food for 2 days, they recovered very well. Conclusions\ It is effective and safe to obtain in vivo ablation of tumors on large animals such as miniswine using high intensity focused ultrasound. This suggests the bright prospect of the clinical use of HIFU in the ablation of human tumors.