经直肠高强度聚焦超声破坏犬前列腺组织的实验研究  

An experimental study on high-intensity focused ultrasound (HIFU) using Sonablate-500 in the ablation of canine prostate

作　　者：吕军[1] 叶章群[1] 胡卫列[2] 王尉[2] 张源锋[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科 [2]广州军区广州总医院泌尿外科

出　　处：《中国男科学杂志》2007年第2期16-20,共5页Chinese Journal of Andrology

基　　金：广东省医学科研基金项目(编号:A2004478);广东省科技计划项目(编号:2004B30301013)

摘　　要：目的探讨经直肠高强度聚焦超声(high-intensity focused ultrasound,HIFU)破坏犬前列腺组织的的安全性、可行性和有效性。方法采用美国Focus Surgery公司生产的第三代HIFUSonablate-500型治疗仪,对16只犬的前列腺进行消融处理,在消融术前,术后30min、30d、60d和180d,经直肠超声观察前列腺和前列腺部尿道的影像学变化;切取前列腺及临近组织和器官,观察其组织病理学变化。结果HIFU前列腺消融术前,前列腺体积为(6.50±3.12)cm3,前列腺部尿道的最大宽度为(0.59±0.11)cm;HIFU消融术60天后前列腺体积为(4.13±2.03)cm3,前列腺部尿道最大宽度为(2.57±0.98)cm。HIFU前列腺消融术后组织学检查,可见前列腺靶区内腺体腺上皮及基质细胞发生均匀性凝固性坏死,60d后消融区的坏死组织脱落,前列腺部尿道呈囊腔状。HIFU前列腺消融区凝固性坏死与正常前列腺组织分界清楚,消融区以外的前列腺及临近组织和器官均无副损伤。HIFU前列腺消融术后并发症主要有尿潴留、尿频和血尿,各实验犬均未发生尿道直肠瘘等并发症。结论HIFU前列腺消融术可彻底破坏消融区的前列腺组织,显著增加前列腺部尿道宽度,对消融区以外的临近组织和器官无副损伤。HIFU前列腺消融术,有望成为临床治疗前列腺疾病的一种可选择的、安全和有效的微创治疗方法。Objective To investigate the safety, feasibility and effectiveness of transrectal high-intensity focused ultrasound （HIFU） in the ablation of canine prostate without injury to the interving and surrounding tissue. Methods The third-generation HIFU device called the Sonablate -500TM （Focus Surgery, Indianapolis, IN, USA） was used. Twenty canines were divided randomly into five groups. Each group included four good health canines. Sixteen canine prostates were treated with transrectal HIFU device. Transrectal ultrasound images of the prostate and prostatic urethral were observed preoperatively and postoperatively. Serial study was performed at 30min, 30 days, 60 days and 180 days after therapy. Two dogs were sacrificed in these periods of time. Hence 20 dogs were treated with one animal sacrificed at same intervals after sham operation. The rectum, periprostatic tissue, and prostate were excised en bloc. Tissues were fixed for gross and histological analysis. Results The prostatic urethral average maximal diameter was （0.59±0.11）cm preoperatively and （2.57±0.98）cm 60 days later postoperatively. The volume of prostate was （6.5±3.12）cm^3 before the treatment while the volume of prostate was （4.13±0.23） cm^3 at 60 days after the treatment. The above differences were significant. Histologically,there was a clear demarcation between necrotic treated tissue and the unaffected surrounding tissue. The coagulative necrosis was histopathologically found in the prostatic stroma and epithelial cells limited to the area of the injury. All the necrosis tissues in the targeted zone fell off and the prostatic urethra became cavitary 60 days late. The border between treated and untreated tissue was extremely sharp. It was free of damage to structures other than the prostatic adenoma, and involved no adverse injury. The canines survived during the trial except one of them died of mistaking toxic food. The more frequent complications were urinary retention, frequency and hematuria. The hematuria and urinar

关 键 词：高强度聚焦超声 前列腺 动物 实验 

分 类 号：R697.3[医药卫生—泌尿科学]