高强度聚焦超声体外破坏原发性肝癌的病理学观察

Pathological study of extracorporeally ablated hepatocellular carcinoma with high-intensity focused ultrasound

目的 探讨高强度聚焦超声 (high intensityfocusedultrasound ,HIFU)体外破坏原发性肝癌(HCC)的病理学变化。方法 HIFU治疗 5 6例HCC患者 ,6例患者治疗后外科手术切除肿瘤 ,观察其病理学变化。结果 在光镜下 ,HIFU治疗区和非治疗区边界清楚 ,治疗区内肿瘤细胞核出现固缩、碎裂或溶解等不可逆性细胞损伤现象 ,血窦结构塌陷 ,内皮细胞受损严重 ,靶区边缘有新生肉芽组织形成 ,逐渐修复坏死组织。在电镜下 ,肿瘤细胞、细胞器和细胞核出现明显损伤 ,细胞膜、核膜连续性丧失 ,核碎裂 ,细胞浆内出现大小不等的小泡样结构。结论 HIFU体外治疗HCC是安全、有效和可行的。

Objective To investigate the pathological changes of hepatocellular carcinoma (HCC) after extracorporeal ablation with high intensity focused ultrasound (HIFU).Methods A total of 56 patients with HCC was treated with HIFU. Of the 56 patients freated, 6 underwnt surgical resection of the tumor 5 to 18 days following HIFU freatment The resected specimens were examined under light and electron microscope.Results Light microscopic examination showed clear boundary between the treated and untreated area. Outside of the boundary the hepatic parenchyma was almost normal. In the treated area, all tumor cells appeared irreversibly dead in the forms of nuclear pyknosis, debris, and dissolution. The blood sinusoids were collapsing with endothelial cell damage. Granulation tissue was formed with the presence of immature fibroblasts and new capillaries in the boundary region between treated and untreated area. Eighteen days after HIFU treatment, the ultrasound damaged area was partially replaced by the proliferative repair tissue. Electronic microscopic examination showed the distorted tumor cells with severe destruction of cell organells and nuclei. The cytoplasm was irregularly vesiculated, and the membranes of the organells were broken. Cell membrane and nuclear membrane disintegration, as well as nucleus disruption were generally observed.Conclusion Extracorporeal treatment of HCC with HIFU proved safe, effective, and feasible. This modality could potentially provide a new and noninvasive therapy for HCC.