What Can I Expect During Ablation Surgery?

Ultrasound ablation surgery mainly includes: two types of ultrasound focusing knife (commonly known as "haifu knife") and ultrasound knife.

Ultrasound ablation surgery

This entry lacks an overview map . Supplementing related content makes the entry more complete and can be upgraded quickly. Come on!

Utilizing ultrasound can pass through human tissues and focus on the characteristics of specific target areas, focusing energy to a sufficient intensity, so that the focus area reaches instantaneous high temperature, destroying the target area tissue, and histopathologically manifests as coagulative necrosis, also called ablation . Thereby, the purpose of destroying the lesion area is achieved, and the tissues outside the lesion area are not damaged.

Image monitoring: Real-time monitoring of ultrasound images is used to determine planned target tumors. The entire treatment process is controlled by the system and timely feedback on the treatment effect is provided.

Accuracy: The energy at the focal point can cause coagulative necrosis of the tissue at the focal point, and there is no damage to surrounding tissues or tissues on the acoustic channel. The border between the treated and non-treated areas is only 6 to 10 cells wide.

(3) Free movement: The free movement of the focus and the monitoring probe in space can realize the stereo combination scanning treatment. The physician can choose a fast, flexible and effective treatment plan according to different patients and different tumors.

Thorough treatment: The treatment planning software of the focused ultrasound tumor treatment system can help physicians accurately lock and remove the entire tumor tissue. There is no upper limit to the volume of tumors that may be treated.

Controllable treatment: Throughout the treatment process, real-time imaging technology can provide video feedback to physicians, and adjust the treatment dose at any time according to digital gray changes.

The whole treatment process is non-trauma, no bleeding, no need for anesthesia, and truly realizes the treatment of tumors in vivo from outside the body and kills the tumor tissue. During the treatment, the ultrasound treatment head is moved to change the depth of focus of the ultrasound, and the combined scanning method of point-line-area-body is adopted to perform conformal ablation of the entire fibroid.

1. Non-invasive treatment

Operate in vitro, completely destroy the lesions in vivo;

No operation, no radioactive damage;

No need for surgical exposure or puncture guidance;

Does not damage the tissues or normal structures outside the target area.

2. Low total cost of treatment

Significantly reduce the length of patient hospitalization;

No blood transfusion during treatment;

Significantly reduce patients' complications during and after surgery

The patient's pain is small, and the body recovers quickly after treatment;

Reduced use of broad-spectrum antibiotics after surgery.

3.Treatment of uniform dose distribution

Scanning treatment in vitro to make the ultrasound energy distribution in the target area uniform;

Solve the problem of minimally invasive interventional therapy (microwave, radio frequency, laser, freezing, etc.) relying on the treatment head for energy diffusion and uneven treatment dose distribution

4 , lethal treatment of target tissues

The target area is the lethal dose of ultrasound, which non-selectively destroys any tissue in the target area;

According to the principle of surgical resection, internal lesions are "removed" from the body.

5 , conformal treatment

Appropriate scanning treatment of the stereo group fully ensures that the lesions in the body are completely destroyed from the outside;

Not limited by tumor shape.

6.Treatment not limited by tumor size

Can completely destroy any size cancer mass in the body.

7. Treatment of selective destruction of blood vessels

Under normal circumstances, only the blood vessels with a diameter of less than 2mm in the tumor are destroyed, effectively ensuring the safety of treatment;

Increasing the treatable range of the lesion, making it possible for local treatment of tumor patients who are partially unable to undergo surgery due to vascular anatomic factors; promoting the repair of local normal tissues

8.Real -time treatment

Stereotactic positioning of the tumor during treatment;

The ultrasonic monitoring device monitors the entire treatment process in real time, effectively preventing off target. Real-time treatment.

9.Treatment to judge the effect in real time

During the treatment, the changes in the target image before, during, and after the treatment were used to timely evaluate whether the tissue in the treatment area had coagulative necrosis and whether the skin was damaged.

10.Dose-controlled treatment

By judging the curative effect of the target area in real time and controlling the therapeutic dose in a feedback manner, the lethal dose in the target area is evenly distributed.

· Chinese People's Liberation Army General Hospital (Beijing 301 Hospital)

· Chinese People's Liberation Army 307 Hospital

· The First Affiliated Hospital of Chongqing Medical University

· The Second Affiliated Hospital of Chongqing Medical University

· Chongqing Three Gorges Central Hospital

· Xijing Hospital Affiliated to the Fourth Military Medical University (Xi'an)

· Jixi People's Hospital of Heilongjiang Province

· Nanshi Hospital Affiliated to Henan University (Nanyang)

· Futian Hospital Affiliated to Guangdong Medical College (Shenzhen)

· Hong Kong Mary Hospital

· The Churchill Hospital, University of Oxford, UK

· European Cancer Center

· Russian National Medical Surgery Center

· Cisanello Hospital, University of Pisa, Italy

· Affiliated Hospital of Chiba University, Japan

· Spanish HMT Hospital

· Russian Central Bank Hospital

· Ultrasonic Ablation Therapy Center, Notre Dame Hospital, Yeouido, Korea

· Japan Clinica ET Clinic Ultrasound Ablation Therapy Center

· Ultrasonic Ablation Therapy Center, American Hospital, Rome, Italy

The ultrasonic knife is not a knife we usually see. It is an ultrasonic wave that can cut the internal tissues of the human body like a real knife using the principle of ultrasound.

The principle of ultrasonic knife to treat tumor is:

It uses the penetrating power of ultrasonic waves and hundreds of beams of high-energy ultrasonic waves (equivalent to 50,000 ordinary B-ultrasound machines) transmitted by ultrasonic transmitters. It gathers the focus on tumor tissues like solar energy, and uses high-energy ultrasonic cavitation to Tumor tissue cell membrane ruptures, and at the same time, high-energy ultrasound releases huge energy and quickly converts it into thermal energy. The temperature of the tumor tissue at the instant focus reaches 70 -100

The ultrasonic knife identifies and locks the tumor like this:

The ultrasonic knife has a tumor recognition system, which can accurately detect the location and size of the tumor, and then transfer these image information to the computer. After receiving this information, the computer can automatically lock the tumor. Under the control of the computer, the ultrasound energy It can pass through the normal tissues of the human body to the tumor tissue without damage, which can kill the tumor cells without hurting the normal tissue around the tumor.

Ultrasound knife treatment and indications are:

Mainly adapt to abdominal, pelvic and body surface tumors. Mainly include: pancreatic cancer, liver cancer, renal and adrenal benign and malignant tumors, gastric cancer, rectal cancer, colon cancer, prostate cancer, prostate hyperplasia, bladder cancer, uterine cancer, uterine fibroids, ovarian cancer, various abdominal and pelvic metastatic cancers .

The ultrasonic knife treatment is not harmful to the human body.The reasons are:

Ultrasound is a mechanical wave that does not contain radiation and does no harm to the human body. Ultrasound knife treatment is a non-invasive treatment method. No surgery or puncture is performed during the treatment, and the patient has no pain during the treatment.

The advantages of ultrasonic knife treatment are:

No operation, no puncture, no bleeding, no trauma, no anesthesia. The effect is reliable. Combined with surgery, chemotherapy, and radiotherapy, the best results can be obtained.

A New Approach to Solid Tumor TherapyHigh Intensity Focused Ultrasound Therapy Apparatus

High-intensity focused ultrasound technology is an ultrasonic surgical treatment technology that has emerged in the 1940s. It focuses the ultrasound energy emitted by ultrasound on human tissues through a certain focusing method, forming a region with a higher sound intensity in the tissue -Focal area, so that the temperature of the tissue in it reaches above 70 ° C within 0.5-5 seconds, resulting in

These tissue cells are coagulated and necrotic without damaging normal tissues outside the focal region, thereby performing tumor treatment. This non-invasive treatment method avoids the toxic and side effects of radiotherapy and chemotherapy and the problem of radioactive accumulation, and can avoid the pain and injury of surgery. It is especially suitable for patients with deep tumor lesions and patients who are not suitable for surgery.

Welcome to doctors and patients. In foreign countries, the development of this product is at the technical research and clinical stage, and it has not yet formed a commodity.

According to experts, the innovation of this system lies in the six spherical concave piezoelectric ceramics spliced into a hemispherical concave self-focusing transducer array. It adopts new technologies such as acoustic matching, first pan-audio work and special three-dimensional curved focus transducers. To obtain better focused ultrasound field and electro-acoustic conversion efficiency; the first domestic 3D reconstruction and calculation

Computer-assisted intervention (CAMI) technology and ablation identification technology are applied to high-intensity focused ultrasound, effectively improving the effectiveness and evaluation of tumor treatment; precise positioning and imaging with multiple degrees of freedom to ensure the accuracy of the product; Inspection function, start the system sound field automatic measurement software, can provide focused sound field parameters

number. The project has obtained a national invention patent.

First, the principle of treatment

The treatment of HIFU is mainly carried out through several aspects.

1. Hyperthermia effect: Generally, the critical point of the lethal temperature of tumor cells is 42.5 ~ 43.0 , while that of normal cells is 45 . For liver tissue, local temperature exceeding 58 can cause coagulative necrosis of the tissue. Different from low-power focused ultrasound, the HIFU therapy instrument can focus high-intensity ultrasound energy on the treatment area.

Within 0.5 seconds, the tissue temperature of the target area was rapidly increased to more than 70 ° C, so that the protein in the cells in the treatment area quickly appeared coagulative necrosis, which produced a therapeutic effect.

2. Cavitation effect: The mechanical expansion of tumor cells is caused by the strong expansion and shrinkage of the air bubbles.

3 Immune effect: Necrotic tumor tissue can also stimulate the body's immunity and produce anti-tumor effects at a later stage.

Treatment characteristics

HIFU produces coagulative necrotic lesions or lesions in the target tissue. Its distinctive feature is that it produces a clear transition zone in the treatment zone and beyond. The transition zone does not exceed 50 m and contains only 5 to 7 layers of cells. It has a direct killing effect on the target tissue, and it has no damage or minor damage to the surrounding tissues, which is different from its

His three-dimensional stereo therapeutic apparatus such as gamma knife etc. (there is still great damage around the target area).

Studies in animal livers have found that the highest temperature in the center of the focal zone of the treatment is 53 ° C. This temperature can completely denature cellular proteins and cause coagulative necrosis of target tissues. In isolated liver tissue, under a certain sound intensity, the longer the irradiation time, the higher the center temperature of the focal area, and the larger the biological focal area, but the outer edge temperature of the focal area is.

The rising areas are roughly the same (both 4.5mm). Anatomical and pathological examinations also confirmed that the boundary between the injured tissue and the surrounding normal tissue was clear. In living liver tissue, the temperature is normal at a distance of 2.5 mm from the periphery of the focal region. The temperature rise area of living tissue is narrower than that of isolated tissue, which may be caused by the heat dissipation of living tissue through the blood flow around the target area. This result

Hint: HIFU can effectively damage the target tissues, while the surrounding tissues are not affected or the effect is small [4].

It is precisely because of the different tissue effects in the target area that HIFU treatment has the following characteristics. Advantages: (1) Non-traumatic: It only affects the tissue in the target area, and its adjacent tissues and organs are not affected. (2) Monitorability: During the treatment, the effect of the treatment can be monitored through the changes of the ultrasound and shadow of tissue necrosis after treatment.

Side effects: Rarely, only a few cause skin damage.

Third, the indications are wide. For solid tumors at a depth of 3-15 cm from the body surface, most of the solid tumors in the abdominal cavity, pelvic cavity, and body surface can be treated with focused ultrasound; for the elderly and weak, or with other organs such as liver, kidney, pancreas Etc.) Patients with complications and other obvious surgical contraindications can also be treated;

Tumors, in addition to locally killing the primary tumor cells, can also be combined with radiotherapy and chemotherapy to improve the therapeutic effect of radiotherapy and chemotherapy; tumors that cannot be removed by surgery, are not sensitive to radiotherapy and chemotherapy, or do not recur after surgery Willing to undergo surgical resection again, at this time, high-intensity focused ultrasound knife can shrink or necrotic tumor entities

, It is beneficial to relieve symptoms, improve the living conditions of patients, improve physical immunity and quality of life of patients.

High Intensity Focused Ultrasound Therapy System (HIFU commonly known as ultrasonic knife) is a hyperthermia method that can cause coagulative necrosis of tumor tissue in vivo from outside. It focuses ultrasound energy at one point by focusing, causing the tissue temperature at the focal point to rise sharply (65 ° C-100 ° C), and destroying tumor tissue through high temperature, which can achieve the purpose of killing tumor cells, while the surrounding normal tissues are not affected. influences.

When ultrasonic waves are transmitted in the human body, the ultrasonic energy is absorbed by the human tissue and converted into thermal energy (in the sun, the light waves are absorbed and converted into thermal energy by the human body). Normal human tissues can take away most of the heat through effective blood circulation, so normal tissues The change in temperature is relatively small and slow, but the tumor tissue due to blood

The amount of fluid circulation is only 2% -15% of normal tissues, and the blood circulation is poor, because it is not heat-resistant and the temperature changes significantly. This characteristic of tumor cells makes it an excellent target for "ultrasonic knives."

During the "ultrasonic knife" treatment, on the one hand, tumor cells undergo coagulative necrosis; on the other hand, their own blood supply vessels are also occluded and coagulated, causing the tumor cells to lose nutrition. The two factors work in concert, eventually leading to the death of the tumor cells and gradually being The body digests and absorbs.

Compared with other tumor treatment methods, the advantages of high-intensity focused ultrasound therapy are: 1. No surgical trauma. 2. The temperature is high, the temperature rises fast, the focus is accurate, and the tumor tissue is instantly coagulated and necrotic. 3. No radiation damage, no protection required. 4. No side effects of chemotherapy. 5. Synergy with chemoradiation.

China's high-intensity focused ultrasound treatment technology began to be used in clinical in 1998. This technology has played a very active role in ablating tumors, improving clinical symptoms of patients, and improving patients' quality of life. It is suitable for the treatment of uterine fibroids, adenomyomas, breast tumors, pelvic and abdominal recurrence and metastatic parenchymal mass, pancreatic cancer, liver cancer, etc. The technology is rapidly spreading at home and abroad, and is becoming more and more popular with patients.

On September 25, 2019, a "Training Course on Developing Countries for Focused Ultrasound Noninvasive Therapy for Oncology in Developing Countries", jointly organized by relevant institutions in China and South Africa, held a closing ceremony in Johannesburg on the 25th. 22 doctors from 13 countries received certificates of completion. ^[1] .