Chartier-Kastler E, Yonneau L, Conort P, Haertig A, Bitker M O, Richard F
Service d'Urologie et de Transplantation rénale et réno-prostatique, Groupe Hospitalier Pitié-Salpêtrière, 83, Boulevard de l'Hôpital, 75013-Paris.
Prog Urol. 2000 Dec;10(6):1108-17.
Focused ultrasound is now well known to urologists in the context of its validated application in extracorporeal lithotripsy. High Intensity Focused Ultrasound (HIFU) represents a potential therapeutic modality for tissue destruction due to its very high energy and its capacity to precisely reach a target with a very short emission time. The authors review the current state of art of HIFU in urology at a time when its indication in prostate cancer is being defined.
After a brief description of the main physical principles of ultrasound and the main data determining focussing of high energy ultrasound, the main machines available (research and clinical) are described. The published clinical literature concerning the tissue destructive action in urology is reviewed.
HIFU has been used in urology to treat renal, vesical, prostatic (BPH and cancer), and external genital organ lesions. Purely extracorporeal machines are gradually being replaced by intracorporeal procedures, especially transrectal techniques for prostatic lesions. The quality of ultrasound detection of the target still limits the use of this minimally invasive modality. The intervening tissues are spared with a good therapeutic efficacy on the target tissues, provided optimal firing parameters are used.
HIFU has a demonstrated potential in the treatment of prostate cancer and studies conducted by several teams have defined the technique and its efficacy. Other indications have been studied, but must be validated by further clinical trials. The future will probably see the design of machines adapted to a specific target tissue rather than a single multidisciplinary extracorporeal machine.
聚焦超声在体外碎石术中的有效应用已为泌尿外科医生所熟知。高强度聚焦超声（HIFU）因其极高的能量以及能够在极短发射时间内精确抵达靶点的能力，成为一种潜在的组织破坏治疗方式。在前列腺癌的适应证正在被明确之际，作者回顾了泌尿外科中HIFU的当前技术水平。
在简要描述超声的主要物理原理以及决定高能超声聚焦的主要数据之后，介绍了现有的主要设备（研究型和临床型）。回顾了已发表的关于泌尿外科组织破坏作用的临床文献。
HIFU已用于泌尿外科治疗肾脏、膀胱、前列腺（良性前列腺增生和癌症）以及外生殖器器官病变。单纯的体外设备正逐渐被体内操作所取代，尤其是用于前列腺病变的经直肠技术。对靶点的超声检测质量仍然限制了这种微创方式的应用。只要使用最佳发射参数，周围组织可得以保留，同时对靶组织具有良好的治疗效果。
HIFU在前列腺癌治疗中已显示出潜力，多个团队开展的研究已明确了该技术及其疗效。其他适应证也已进行研究，但必须通过进一步的临床试验加以验证。未来可能会出现针对特定靶组织设计的设备，而非单一的多学科体外设备。
