镇静止痛条件下聚焦超声治疗实体肿瘤的初步临床研究  

Clinical analysis of treatment of solid tumors with high intensity focused ultrasound(HIFU) under sedation and analgesia

作　　者：杨武威[1] 李静[1] 盖绿华[1] 祝保让[1] 夏文秀[1] 周洁敏[1] 杨涛[1] 

机构地区：[1]解放军第307医院超声聚焦刀科,北京100071

出　　处：《解放军医学杂志》2008年第6期767-768,778,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的初步评价镇静止痛条件下采用高强度聚焦超声(HIFU)对良性和晚期恶性肿瘤患者实施消融和姑息性消融治疗的安全性和有效性。方法静脉应用芬太尼(1μg/kg)及咪唑安定(0.03mg/kg)创建镇静止痛条件,应用JC型HIFU治疗系统对23例良性和58例晚期恶性肿瘤患者实施消融和姑息性消融治疗,观察镇静止痛药物及HIFU消融治疗的近期疗效、不良反应。结果在镇静止痛条件下,81例患者共进行112例次HIFU消融手术,其中23例良性肿瘤患者治疗26例次,58例恶性肿瘤患者姑息性治疗86例次,共治疗153个病灶。在可评价的疗效中,病灶体积消融率达到50%以上的病灶占81%(89/110),其中恶性肿瘤为72.2%(52/72),良性肿瘤为97.4%(37/38)。恶性肿瘤患者中81.3%(13/16)的患者肿瘤标志物下降>50%;肿瘤相关症状缓解率77%(30/39)。镇静止痛药物不良反应包括恶心、呼吸频率过缓、幻视等,HIFU治疗的主要副反应包括,治疗区疼痛及肿胀等。未出现三度以上镇静止痛药物或HIFU治疗的相关并发症。结论在镇静止痛条件下,HIFU消融治疗实体肿瘤具有较好的安全性、有效性和可操作性。Objective To evaluate the safety and clinical efficacy of high intensity focused ultrasound （HIFU） for patients with solid tumors under sedation and analgesia. Methods Sedation and analgesia were induced with i.v. fentanyl（1μg/kg） and midazolam （0. 03mg/ kg） in 81 patients with benign or malignant solid tumors. High intensity focused ultrasound （HIFU） ablation treatment was then performed. The short-term effect and adverse events of sedatives and analgesics, as well as the effect of HIFU ablation treatment were observed. Results One hundred and twelve HIFU courses were performed on 81 patients, among them 23 patients with benign solid tumors received 26 courses of treatment, and 58 patients with malignant solid tumors, received 86 courses of treatment. A total of 153 foci were targeted. It was estimated that in 81% of all the patients, the tumor size was decreased by 50%, including 72. 2%（52/72）of malignant tumors and 97. 4V0（37/38）of benign tumors. Tumor markers of malignant tumors decreased by more than 50% in 81.3%（13/16） of patients, and remission rate of tumor-related symptoms reached 77. 9 % （30/39）. The adverse events during sedation and analgesia were nausea, reduction in the respiratory rate, visual hallucination, and that of HIFU were pain and swelling. No comblications with severity surpassing grade Ⅲ were found as a result of either sedatives, analgesics or HIFU treatment. Conclusion Sedation and analgesia are relatively safe, effective and feasible during HIFU treatment for solid tumor.

关 键 词：高强度聚焦超声(HIFU) 实体肿瘤 超声消融 

分 类 号：R454[医药卫生—治疗学] R73[医药卫生—临床医学]