高强度聚焦超声治疗胰腺癌的胃肠道准备(一)

1、高强度聚焦超声治疗胰腺癌的胃肠道准备(一)    作者：张惠芳，徐叶青，贺蓓蓓【摘要】 目的 探讨高强度聚焦超声（high intensive focused ultrasound,HIFU）治疗胰腺癌的胃肠道准备要点。方法 胰腺癌患者45例，共行HIFU治疗262次，治疗前先服用扶正祛邪、疏肝理气、消食化积的中草药34天，采用胃肠减压者74例次，术前单纯禁食者26例次，禁食后术前510min加服脱气水者6例次，加服胃肠检查用超声助显剂156例次。结果 胃肠减压的74例次和禁食后服用胃肠检查用超声助显剂的156例次，均顺利完成治疗，禁食后空腹治疗的26例

2、次有8例次（30.8%）、服用脱气水的6例次中有2例次（33.3%）因胃肠气体过多未完成治疗。结论 术前给予扶正祛邪、疏肝理气、消食化积的中草药，是驱除胃肠道积气的有效方法，为进一步准备做了铺垫。禁食后空腹、服用脱气水者治疗后期胃肠气体过多影响疗效。胃肠减压能将胃肠道气体完全排尽却受操作繁复、患者痛苦的局限而不能广泛使用。服用胃肠检查用超声助显剂驱气便捷、无痛苦、效果肯定，可作为超声治疗胃肠道准备的首选。【关键词】 高强度聚焦超声；胰腺癌；胃肠道准备【Abstract】 Objective To study the key points about a gastrointestinal （GI

3、） preparation for treating a pancreatic cancer with high intensive focused ultrasound （HIFU）.Methods 45 patients with pancreatic cancer were treated with HIFU for 262 person-times.Before treating,these patients have first taken a Chinese herbal acting as strengthening the body resistance to eliminat

4、e pathogenic factors,reliving the depressed liver,sooting the liver and regulating the circulation of qi（气）,promoting digestion and digestant for 34 days.In 262 person-times,74 person-times were adopted GI decompression （GID）,510 minutes before operation 26 person-times ware adopted simple fast,6 pe

5、rson-times were additionally taken airless water,and 156 person-times were additionally taken ultrasonic developer-aid （UDA） for the use of GI examination.Results Both 74 person-times adopted GID and 156 person-times taken UDA after fast were successfully completed the treatment.Both 8 person-times

6、among 26 person-times （30.8%） treated after fast and empty stomach,and 2 person-times among 6 person-times taken airless water （33.3%） cant be completed the treatment because of excessive gas in GI.Conclusion Taking above all the things Chinese herbal before operation is an effective method driving

7、out the pneumatosis in GI.It foreshadows a follow-up and further preparative.Both empty stomach after fast and to take airless water affect the curative effect in later stage of the treatment because of the excessive gas of GI.The GID can fully eliminate the gas of GI,but it cant be used extensively

8、 because its manipulation is complicated,and the patients are painful.Driving out the gas of GI by taking UDA is handy and painless and its affirmative effect is confirmed,so it has became first selection of GI preparation for the ultrasound treatment.【Key words】 high intensive focused ultrasound;pa

9、ncreatic cancer;gastrointestinal preparation高强度聚焦超声（high intensive focused ultrasound,HIFU）治疗胰腺癌是近年来新兴的治疗方法，因超声波不能透过气体，超声治疗是以脱气水为介质发射的高强度超声波为能源来实现治疗目的的，故术前驱除胃肠道的气体对提高疗效、减少或避免并发症具有相当意义。现将45例胰腺癌接受HIFU治疗患者的胃肠道准备体会报告如下。1 资料与方法1.1 一般资料 本组45例患者采用FEP-BY01型高强度聚焦超声肿瘤治疗仪共进行262次HIFU治疗，术前胃肠道准备采用胃肠减压者74例次，术前单纯禁食

10、者26例次，禁食后术前510min加服脱气水者6例次，加服胃肠检用超声助显剂156例次。1.2 方法 本组208例次采用术前34天服用扶正祛邪、疏肝理气、消食化积的中草药。74例次术前46h胃肠减压；6例次术前810h禁食，23h禁水，术前510min一次性服用脱气水300400ml；156例次术前510min一次性服用胃肠检用超声助显剂300400ml；空腹26例次。2 结果本组45例患者共进行262次HIFU治疗，胃肠道准备采用胃肠减压的74例次和禁食后服用胃肠检查用超声助显剂的156例次，胃肠道气体驱除彻底均顺利完成治疗。禁食后空腹治疗的26例次有8例次（30.8%）未完成治疗，其中3例

11、次因胃肠气体过多无法定位而未治疗，5例次因治疗中有较多气体产生而终止治疗。禁食后服用脱气水的6例次中有2例次（33.3%）因治疗中后期胃内脱气水的排空被较多气体替代而终止治疗。3 讨论HIFU治疗的原理是将多束超声在体内聚焦后产生的热效应来杀死肿瘤细胞，而靶区焦点的实时温度尚无法准确测量1，超声波经过含气脏器时，几乎被完全反射2，胰腺为后腹膜器官，路径前方的胃腔内气体是超声入射的最大障碍3，鉴于这些特性如果在进行HIFU治疗前没有充分的胃肠道准备不仅影响术前定位、术中疗效，甚至会因超声波的反射而造成非治疗部位烫伤的并发症，因此胃肠道准备必须要充分。胰腺癌是消化系统常见的恶性肿瘤之一，它起病隐匿

12、，早期多被忽视，确诊病例以中晚期居多，此时消化不良、体质虚弱抗病能力低下是其共有的特性，术前给予扶正祛邪、疏肝理气、消食化积的中草药，对减轻症状帮助消化排除积气提高抗病力具有显著效果，从而增加了患者机体的抵抗力及战胜疾病的信心，同时也有效地驱除了胃肠道的积气，为后续准备做了铺垫。本组54例次未服用中草药因胃肠道积气很多，只能采取胃肠减压术后再行治疗。本组26例次服中草药后采用单纯禁食定位后直接治疗，6例次服用脱气水后治疗，采取这两种方法治疗在定位时胰腺及肿瘤的显示尚较满意的29例次，但随着治疗的进行，局部温度的提高，胃肠蠕动加速，有7例次因气体增多而终止治疗。服用脱气水后因水在胃内排空快，其效用仅显现在服用后的定位及治疗初期，故临床意义不大。本组156例次术前采取服用胃肠检查用超声助显剂驱气，服用后助显剂快速填充胃腔，胃内几无残存的气体，形成良好的透声窗，驱气效果和胰腺及肿瘤显示效果均优于空腹、服用脱气水，且胃内排空时间可维持至治疗结束3；患者禁食后自觉饥饿，喝下糊状的助显剂也可充饥，使患者更好地配合治疗，临床效果良好。本组74例次术前采用胃肠减压术，减压46h后胃肠道气体完全排尽，给定位、治疗创造良好的条件，但是，胃肠减压需先置入胃管且每次治疗均需插一次，给患者带来一定的痛苦，而胰腺癌中晚期患者