摘要目的采用高能聚焦超声(high intensity focused ultrasound, HIFU)技术治疗中晚期胰腺癌,观察HIFU对胰腺肿瘤的杀伤效应及缓解胰腺癌疼痛的有效性,并探讨其对机体免疫功能的影响. 方法采用HIFU分次完全覆盖疗法,对15例晚期胰腺癌患者进行治疗,通过治疗前后临床症状、病灶体积及回声变化、血清CA19-9、 CA242、CD3+、CD4+、CD4+/CD8+值和NK细胞活性等指标观察HIFU的治疗效果. 结果治疗后胰腺癌患者临床症状减轻,疼痛症状明显缓解,CA19-9、CA242水平下降,病灶B超回声增强,无严重并发症出现,饮食、睡眠及精神状态均有明显改善,生存质量提高.CD3+、CD4+细胞数量及CD4+/CD8+值有不同程度升高,NK细胞活性显著增强(P<0.05 ). 结论 HIFU治疗晚期胰腺癌是安全和可行的,可导致肿瘤坏死,缓解疼痛症状,增强机体的细胞免疫功能,该技术的应用将为临床非侵入性治疗晚期胰腺癌提供一个新的治疗手段.

abstractsObjectives To observe the efficacy of high intensity focused ultrasound (HIFU) in the treatment of late-stage pancreatic carcinoma and evaluate its influence on cell-mediated immunity in the host. Methods Fifteen patients with late-stage pancreatic carcinoma had their tumor tissue completely destroyed with HIFU. Evaluation of efficacy was made on the basis of clinical symptom changes, variations in tumor echo, changes in pancreatic amylase, serum CA19-9 and CA242, CD3+, CD4+ subsets, CD4+/CD8+ ratios and NK cell activity. Results Clinical symptoms such as pain were significantly alleviated, echo of tumor was enhanced with B-US, CA19-9 and CA242 were decreased and pancreatic amylase showed no change. Eating, sleeping and mental status were all markedly improved; no serious complications were seen. On the other hand, NK cell activity was significantly enhanced in 10 patients (P<0.05), and CD3+ and CD4+ subsets as well as CD4+/CD8+ ratios increased to different degrees.Conclusions The use of HIFU in the treatment of late-stage pancreatic carcinoma is feasible and safe. It is effective in destroying the carcinoma and alleviating abdominal pain; it may enhance cell-mediated immunity in the host. This technique may offer a noninvasive therapy for the treatment of late-stage pancreatic carcinoma.