Nissenkorn I, Meshorer A
Department of Urology, Meir General Hospital, Kfar Saba, Israel.
J Urol. 1993 Jun;149(6):1613-6. doi: 10.1016/s0022-5347(17)36461-3.
Intraprostatic temperature measurements during transurethral hyperthermia at 44.5C were obtained in 5 dogs. Temperatures were also recorded in the bladder neck wall and the rectal wall. After completion of the temperature measurements, hyperthermia was continued for 3 hours. The prostates were then removed and taken for histologic examination immediately after hyperthermia and 1 week and 1 month later. The mean temperatures obtained in the 5 canine prostates were 44.5 +/- 0.4C at the heating electrode; 43.8 +/- 0.4C at a distance of 3 mm. from the electrode; 42.6 +/- 0.5C, 40.8 +/- 0.4C and 39.4 +/- 0.5C, 6, 9 and 12 mm. from the heating electrode, respectively, in the right, prostatic lobe. Similar temperatures were measured in the left lobe. The thermal gradient in the prostatic tissue was therefore about 4C per 1 cm. On histology, hemorrhagic necrosis of the prostatic tissue adjacent to the urethra was found. These histologic changes were found as much as 5 mm. from the heating antenna (where the temperatures measured were above 43C). The findings of our study may have major clinical importance. We found that thermal energy above 43C provides enough penetration to cause tissue damage and be clinically effective in most patients, while the thermal gradient around the heating electrode of 4C per 1 cm. is steep enough to confine histologic damage within the prostate.
对5只犬进行经尿道热疗,测量前列腺内温度,温度设定为44.5℃。同时记录膀胱颈壁和直肠壁的温度。温度测量完成后,继续热疗3小时。热疗结束后立即、1周后及1个月后分别取出前列腺进行组织学检查。5只犬前列腺内的平均温度在加热电极处为44.5±0.4℃;在距电极3mm处为43.8±0.4℃;在右侧前列腺叶距加热电极6mm、9mm和12mm处分别为42.6±0.5℃、40.8±0.4℃和39.4±0.5℃。左侧叶测得类似温度。因此,前列腺组织中的热梯度约为每1cm 4℃。组织学检查发现,尿道周围的前列腺组织有出血性坏死。这些组织学变化在距加热天线5mm处即可发现(此处测得的温度高于43℃)。我们的研究结果可能具有重要的临床意义。我们发现,43℃以上的热能具有足够的穿透力,可导致组织损伤,且对大多数患者具有临床疗效,同时加热电极周围每1cm 4℃的热梯度足够陡峭,可将组织学损伤局限在前列腺内。