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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 destruction of canine prostate tissue. Methods The third generation of HIFUSonablate-500 therapeutic instrument manufactured by Focus Surgery Company of USA was used to ablate the prostate of 16 dogs. Prostate and prostate were observed by rectal ultrasound before ablation, 30min, 30d, 60d and 180d after operation Department of urethral imaging changes; cut off the prostate and adjacent tissues and organs, observed histopathological changes. Results Before HIFU prostatic ablation, the volume of the prostate was (6.50 ± 3.12) cm3 and the maximum width of the urethra in the prostate was (0.59 ± 0.11) cm. The volume of the prostate was (4.13 ± 2.03) cm3 after 60 days of HIFU ablation, The width is (2.57 ± 0.98) cm. HIFU histological examination of the prostate after ablation, we can see the prostate glandular epithelial cells and stromal cells of the homogeneous coagulation necrosis, necrotic tissue ablation area 60 days after the ablation, prostate urethra was cystic. HIFU prostate ablation area coagulation necrosis and normal prostate tissue demarcation clear, ablation area outside the prostate and adjacent tissues and organs without secondary injury. HIFU complications after prostatectomy mainly urinary retention, frequent urination and hematuria, the experimental dogs did not occur complications such as urethral fistula. Conclusions HIFU prostatic ablation can completely destroy the prostate tissue in the ablation zone, significantly increase the width of the urethra in the prostatic urethra, and have no secondary injury to the adjacent tissues and organs outside the ablation zone. HIFU prostate ablation is expected to become an alternative, safe and effective minimally invasive treatment for the treatment of prostate diseases in clinic.