High-intensity focused ultrasound(HIFU)is a noninvasive modality that uses an extracorporeal source of focused ultrasound energy.This technique was introduced by Lynn et al and is able to induce coagulative necrosis i...High-intensity focused ultrasound(HIFU)is a noninvasive modality that uses an extracorporeal source of focused ultrasound energy.This technique was introduced by Lynn et al and is able to induce coagulative necrosis in selected tissues without damaging adjacent structures.Although HIFU has been studied for 50years,recent technological developments now allow its use for tumours of the liver,prostate and other sites.In liver disease,HIFU has been used to treat unresectable,advanced stages of hepatocellular carcinoma(HCC)and liver metastases.Hepatocellular carcinoma is a serious health problem worldwide and is endemic in some areas because of its association with hepatitis B and C viruses(in 20%of cases).Liver transplantation(LT)has become one of the best treatments available because it removes both the tumour and the underlying liver disease such as cirrhosis(which is present in approximately 80%of cases).The prerequisite for longterm transplant success depends on tumour load and strict selection criteria regarding the size and number of tumour nodules.The need to obtain the optimal benefit from the limited number of organs available has prompted strict selection criteria limited to only those patients with early HCC who have a better long-term outcome after LT.The so-called"bridging therapy"has the aim of controlling disease burden for patients who are on the organ transplant waiting list.Amongst various treatment options,transarterial chemoembolisation and radiofrequency ablation are the most popular treatment choices.Recently,Cheung et al demonstrated that HIFU ablation is a safe and effective method for the treatment of HCC patients with advanced cirrhosis as a bridging therapy and that it reduced the dropout rate from the liver transplant waiting list.In this commentary,we discuss the current value of HIFU in the treatment of liver disease,including its value as a bridging therapy,and examine the potential advantages of other therapeutic strategies.展开更多
The scarcity of liver grafts in Asia leads to a significant dropout of patients from liver transplant waiting lists, particularly patients with hepatocellular carcinoma and a low model for end-stage liver disease scor...The scarcity of liver grafts in Asia leads to a significant dropout of patients from liver transplant waiting lists, particularly patients with hepatocellular carcinoma and a low model for end-stage liver disease score. In order to reduce dropping out, different bridging therapies are employed. We report the use of high-intensity focused ultrasound ablation as a bridging therapy for a patient with hepatocellular carcinoma of stage two and an extremely low platelet count (20×10 9 /L). The ablation was successful. Blood tests showed that his liver function was similar before and after the treatment. No adhesion was encountered in the liver transplantation performed six months later.展开更多
AIM:To analyze whether high-intensity focused ultrasound(HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma(HCC).METHODS:From January 2007 to December 2010,49 consecutive HCC pa...AIM:To analyze whether high-intensity focused ultrasound(HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma(HCC).METHODS:From January 2007 to December 2010,49 consecutive HCC patients were listed for liver transplantation(UCSF criteria).The median waiting time for transplantation was 9.5 mo.Twenty-nine patients received transarterial chemoembolization(TACE) as a bringing therapy and 16 patients received no treatment before transplantation.Five patients received HIFU ablation as a bridging therapy.Another five patients with the same tumor staging(within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison.Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores,tumor size and number,and cause of cirrhosis.RESULTS:The HIFU group and TACE group showed no difference in terms of tumor size and tumor number.One patient in the HIFU group and no patient in the TACE group had gross ascites.The median hospital stay was 1 d(range,1-21 d) in the TACE group and two days(range,1-9 d) in the HIFU group(P < 0.000).No HIFU-related complication occurred.In the HIFU group,nine patients(90%) had complete response and one patient(10%) had partial response to the treatment.In the TACE group,only one patient(3%) had response to the treatment while 14 patients(48%) had stable disease and 14 patients(48%) had progressive disease(P = 0.00).Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list(P = 0.559).CONCLUSION:HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis.It may reduce the drop-out rate of liver transplant candidate.展开更多
目的评价介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌的疗效及安全性。方法计算机检索Cochrane图书馆、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang八大数据库,同时辅以其他检索,收集所有介入化疗栓塞术联合高强度...目的评价介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌的疗效及安全性。方法计算机检索Cochrane图书馆、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang八大数据库,同时辅以其他检索,收集所有介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌的随机对照试验。两位评价员按照研究计划书进行文献筛选和资料提取,对纳入文献进行质量评价后,使用RevMan 5.1软件进行Meta分析。结果共纳入15篇随机对照试验(1 103例患者)。Meta分析结果显示:①联合组0.5年[风险比5.12,95%可信区间(3.46,7.58)],1年[风险比3.03,95%可信区间(2.26,4.06)],2年[风险比3.51,95%可信区间(2.45,5.02)],3年[风险比3.60,95%可信区间(2.42,5.37)],5年[风险比4.70,95%可信区间(2.41,9.17)]的总生存率和总有效率均明显好于介入化疗栓塞术组,且差异均有统计学意义(P<0.05)。②联合组白细胞下降、恶心呕吐、肝功损害的发生率均低于介入化疗栓塞术组,但只有恶心呕吐发生率的差异有统计学意义;联合组发热反应的发生率高于介入化疗栓塞术组,且差异有统计学意义(P<0.05)。结论相较于单纯介入化疗栓塞术,介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌能提高患者远期生存率和近期疗效,且安全性很好,但其长期疗效和安全性评价尚需大样本高质量的随机对照试验进一步验证。展开更多
目的:对兔肝VX2肿瘤进行高强度聚焦超声(HIFU)联合超声造影剂微泡SonoVue消融治疗,运用超声造影(CEUS)和增强螺旋CT(CECT)对比病理结果研究检测残瘤的能力。方法:将40只兔肝VX2肿瘤动物模型随机分为假照组(n=10)、单纯HIFU组(n=15)和HIF...目的:对兔肝VX2肿瘤进行高强度聚焦超声(HIFU)联合超声造影剂微泡SonoVue消融治疗,运用超声造影(CEUS)和增强螺旋CT(CECT)对比病理结果研究检测残瘤的能力。方法:将40只兔肝VX2肿瘤动物模型随机分为假照组(n=10)、单纯HIFU组(n=15)和HIFU联合微泡组(n=15),在消融前后3 h内完成CEUS和CECT检查,分析肿瘤血供变化及残瘤的检测情况,然后即刻处死,对肿瘤的消融情况及有无残瘤行病理学检查并结合影像学结果对比分析。结果:40灶兔肝VX2肿瘤在消融前CEUS和CECT分别表现为动脉相整体增强(77.5%,31/40 vs 52.5%,21/40)和厚环状增强(22.5%,9/40 vs 47.5%,19/40),均为动脉相富血供,门脉相迅速消退,呈"快进快出"。HIFU联合微泡组的平均辐照时间、辐照点数及电功率均较单纯HIFU组为低(P<0.01)。消融后,假照组影像学无明显变化,病理组织学显示肿瘤内丰富的微血管形成;单纯HIFU组和HIFU联合微泡组中分别有60.0%(9/15)和13.3%(2/15)残瘤存在。CEUS对这两组的残瘤检出率高于CECT,CEUS和CECT检测残瘤同病理诊断的一致率分别为81.8%和27.3%,两者比较差异有统计学意义(P<0.05)。结论:HIFU联合微泡可以提高兔肝VX2肿瘤的消融效果,减少残瘤发生率,CEUS检测残瘤的能力优于CECT。展开更多
文摘High-intensity focused ultrasound(HIFU)is a noninvasive modality that uses an extracorporeal source of focused ultrasound energy.This technique was introduced by Lynn et al and is able to induce coagulative necrosis in selected tissues without damaging adjacent structures.Although HIFU has been studied for 50years,recent technological developments now allow its use for tumours of the liver,prostate and other sites.In liver disease,HIFU has been used to treat unresectable,advanced stages of hepatocellular carcinoma(HCC)and liver metastases.Hepatocellular carcinoma is a serious health problem worldwide and is endemic in some areas because of its association with hepatitis B and C viruses(in 20%of cases).Liver transplantation(LT)has become one of the best treatments available because it removes both the tumour and the underlying liver disease such as cirrhosis(which is present in approximately 80%of cases).The prerequisite for longterm transplant success depends on tumour load and strict selection criteria regarding the size and number of tumour nodules.The need to obtain the optimal benefit from the limited number of organs available has prompted strict selection criteria limited to only those patients with early HCC who have a better long-term outcome after LT.The so-called"bridging therapy"has the aim of controlling disease burden for patients who are on the organ transplant waiting list.Amongst various treatment options,transarterial chemoembolisation and radiofrequency ablation are the most popular treatment choices.Recently,Cheung et al demonstrated that HIFU ablation is a safe and effective method for the treatment of HCC patients with advanced cirrhosis as a bridging therapy and that it reduced the dropout rate from the liver transplant waiting list.In this commentary,we discuss the current value of HIFU in the treatment of liver disease,including its value as a bridging therapy,and examine the potential advantages of other therapeutic strategies.
文摘The scarcity of liver grafts in Asia leads to a significant dropout of patients from liver transplant waiting lists, particularly patients with hepatocellular carcinoma and a low model for end-stage liver disease score. In order to reduce dropping out, different bridging therapies are employed. We report the use of high-intensity focused ultrasound ablation as a bridging therapy for a patient with hepatocellular carcinoma of stage two and an extremely low platelet count (20×10 9 /L). The ablation was successful. Blood tests showed that his liver function was similar before and after the treatment. No adhesion was encountered in the liver transplantation performed six months later.
文摘AIM:To analyze whether high-intensity focused ultrasound(HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma(HCC).METHODS:From January 2007 to December 2010,49 consecutive HCC patients were listed for liver transplantation(UCSF criteria).The median waiting time for transplantation was 9.5 mo.Twenty-nine patients received transarterial chemoembolization(TACE) as a bringing therapy and 16 patients received no treatment before transplantation.Five patients received HIFU ablation as a bridging therapy.Another five patients with the same tumor staging(within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison.Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores,tumor size and number,and cause of cirrhosis.RESULTS:The HIFU group and TACE group showed no difference in terms of tumor size and tumor number.One patient in the HIFU group and no patient in the TACE group had gross ascites.The median hospital stay was 1 d(range,1-21 d) in the TACE group and two days(range,1-9 d) in the HIFU group(P < 0.000).No HIFU-related complication occurred.In the HIFU group,nine patients(90%) had complete response and one patient(10%) had partial response to the treatment.In the TACE group,only one patient(3%) had response to the treatment while 14 patients(48%) had stable disease and 14 patients(48%) had progressive disease(P = 0.00).Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list(P = 0.559).CONCLUSION:HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis.It may reduce the drop-out rate of liver transplant candidate.
文摘目的评价介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌的疗效及安全性。方法计算机检索Cochrane图书馆、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang八大数据库,同时辅以其他检索,收集所有介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌的随机对照试验。两位评价员按照研究计划书进行文献筛选和资料提取,对纳入文献进行质量评价后,使用RevMan 5.1软件进行Meta分析。结果共纳入15篇随机对照试验(1 103例患者)。Meta分析结果显示:①联合组0.5年[风险比5.12,95%可信区间(3.46,7.58)],1年[风险比3.03,95%可信区间(2.26,4.06)],2年[风险比3.51,95%可信区间(2.45,5.02)],3年[风险比3.60,95%可信区间(2.42,5.37)],5年[风险比4.70,95%可信区间(2.41,9.17)]的总生存率和总有效率均明显好于介入化疗栓塞术组,且差异均有统计学意义(P<0.05)。②联合组白细胞下降、恶心呕吐、肝功损害的发生率均低于介入化疗栓塞术组,但只有恶心呕吐发生率的差异有统计学意义;联合组发热反应的发生率高于介入化疗栓塞术组,且差异有统计学意义(P<0.05)。结论相较于单纯介入化疗栓塞术,介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌能提高患者远期生存率和近期疗效,且安全性很好,但其长期疗效和安全性评价尚需大样本高质量的随机对照试验进一步验证。
文摘目的:对兔肝VX2肿瘤进行高强度聚焦超声(HIFU)联合超声造影剂微泡SonoVue消融治疗,运用超声造影(CEUS)和增强螺旋CT(CECT)对比病理结果研究检测残瘤的能力。方法:将40只兔肝VX2肿瘤动物模型随机分为假照组(n=10)、单纯HIFU组(n=15)和HIFU联合微泡组(n=15),在消融前后3 h内完成CEUS和CECT检查,分析肿瘤血供变化及残瘤的检测情况,然后即刻处死,对肿瘤的消融情况及有无残瘤行病理学检查并结合影像学结果对比分析。结果:40灶兔肝VX2肿瘤在消融前CEUS和CECT分别表现为动脉相整体增强(77.5%,31/40 vs 52.5%,21/40)和厚环状增强(22.5%,9/40 vs 47.5%,19/40),均为动脉相富血供,门脉相迅速消退,呈"快进快出"。HIFU联合微泡组的平均辐照时间、辐照点数及电功率均较单纯HIFU组为低(P<0.01)。消融后,假照组影像学无明显变化,病理组织学显示肿瘤内丰富的微血管形成;单纯HIFU组和HIFU联合微泡组中分别有60.0%(9/15)和13.3%(2/15)残瘤存在。CEUS对这两组的残瘤检出率高于CECT,CEUS和CECT检测残瘤同病理诊断的一致率分别为81.8%和27.3%,两者比较差异有统计学意义(P<0.05)。结论:HIFU联合微泡可以提高兔肝VX2肿瘤的消融效果,减少残瘤发生率,CEUS检测残瘤的能力优于CECT。
