Cranston David, Leslie Tom, Ter Haar Gail
Nuffield Department of Surgery, University of Oxford, Oxford OX3 9DU, UK.
Oxford University Hospitals Foundation Trust, Oxford OX3 7LE, UK.
Cancers (Basel). 2021 Nov 14;13(22):5696. doi: 10.3390/cancers13225696.
This review provides an introduction to high-intensity focused ultrasound (HIFU) and reviews its historical and current use in urological surgery. Current and historical literature (1927-2020), including that describing trials and review articles in the medical and ultrasonic literature, has been reviewed, using Pub Med and Cochrane search engines. HIFU is currently one of a number of treatments for prostate cancer, both as a primary treatment that can be repeated, and as a salvage treatment post-radiotherapy. HIFU is not yet sufficiently mature to be a standard treatment for renal cancer or other urological diseases, although there has been some success in early clinical trials. As the technology improves, this situation is likely to change. HIFU has been understood as a concept for a century, and has been applied in experimental use for half that time. It is now an accepted treatment with low morbidity in many diseases outside the scope of this review. In urological surgery, prostate HIFU is accepted as a localised treatment in selected cases, with potentially fewer side effects than other localised therapies. Currently the treatment for renal cancer is hindered by the perinephric fat and the position of the kidneys behind the ribs; however, as the technology improves with image fusion, faster treatments, and the ability with phased array transducers and motion compensation to overcome the problems caused by the ribs and breathing, successful treatment of kidney tumours will become more of a reality. In due course, there will be a new generation of machines for treating prostate cancer. These devices will further minimise the side effects of radical treatment of prostate cancer.
本综述介绍了高强度聚焦超声（HIFU），并回顾了其在泌尿外科手术中的历史和当前应用情况。使用PubMed和Cochrane搜索引擎，对1927年至2020年的现有及历史文献进行了综述，其中包括医学和超声文献中描述的试验及综述文章。HIFU目前是前列腺癌的多种治疗方法之一，既作为一种可重复的主要治疗方法，也作为放疗后的挽救治疗方法。尽管早期临床试验取得了一些成功，但HIFU作为肾癌或其他泌尿系统疾病的标准治疗方法仍不够成熟。随着技术的改进，这种情况可能会改变。HIFU作为一个概念已被理解了一个世纪，并且已经有半个世纪的实验应用历史。现在，在本综述范围之外的许多疾病中，它已成为一种公认的低发病率治疗方法。在泌尿外科手术中，前列腺HIFU在某些特定病例中被视为一种局部治疗方法，其副作用可能比其他局部治疗方法更少。目前，肾癌的治疗受到肾周脂肪和肾脏位于肋骨后方位置的阻碍；然而，随着图像融合、更快治疗以及相控阵换能器和运动补偿技术的改进，能够克服肋骨和呼吸带来的问题，成功治疗肾肿瘤将更有可能成为现实。在适当的时候，将会出现新一代治疗前列腺癌的机器。这些设备将进一步减少前列腺癌根治性治疗的副作用。
