超声造影在高强度聚焦超声治疗中晚期前列腺癌应用

Application of ultrasound contrast agents in high-intensive focused ultrasound for clinical treatment of middle-late stage prostate cancer

目的探讨超声造影在高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗中晚期前列腺癌的临床应用价值。方法将10例中晚期前列腺癌病例别行高强度聚焦超声治疗。治疗过程中行超声造影检查,通过病灶血流信号变化判断消融效果。所有病例随访1年,在术前、治疗后1、2、6和12个月,经直肠超声观察前列腺和前列腺部尿道的影像学变化,通过尿液分析、国际前列腺症状(IPSS)评分、生活质量(QOL)评分、最大尿流率(Qmax)和残余尿量(PVR)进行疗效评估。结果随访12个月,治疗前、治疗后1、2、6和12个月患者IPSS评分、QOL评分逐渐降低,Qmax逐渐升高,PVR逐渐降低,前列腺体积逐渐降低,动脉收缩期峰值速度(Vs)、舒张末期速度(Vd)、阻力指数(RI)、加速指数(AI)、血管内径(D)均逐渐降低,差异有显著性(P<0.05)。结论 HIFU是治疗前列腺癌安全有效的方法,超声造影能准确显示HIFU治疗前列腺癌的消融范围及程度,且超声造影剂可以起到增效剂的作用经直肠彩色多普勒超声为其疗效评估提供了一种直观,准确的方法。

[ Objective ] To study ultrasound contrast agents in high-intensive focused ultrasound for middle-late stage prostate cancer. [Methods] 10 cases of middle-late stage prostate cancer were treated with the Sonablat - 500TM therapeutic system. The prostates were observed by transreetal color doppler flow imaging （CDFI） and ultra- sound contrast pre-and post -treatment. 60 patients after treatment were followed up 12 months. [ Result ] The mean IPSS symptomseore was improved. QQL index became lower, while Qmax improved, PVR decreased （P 〈0.01） and volume of prostate reduced （P 〈0.05） significantly. The systolic velocity （VS）, diastolic velocity （VD）, resistent index （RI）, blood vessel inside diameter （D）, accelerate index （AI）, were significantly decreased after treatment （P 〈0.01 ）. [ Conclusion ] HIFU for prostate cancer is safe and effective method, ultrasonic contrast can accurately show that HIFU prostate cancer treatment of the ablation range and degree, and ultrasound contrast agents can play the role of the enhancing transrecta] color doppler ultrasound for its curative effect evaluation with an intuitive, accurate method.