Histotripsy homogenization of the prostate: thresholds for cavitation damage of periprostatic structures.
Histotripsy homogenization of the prostate: thresholds for cavitation damage of periprostatic structures.
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前列腺组织解剖均质化：前列腺周围结构空化损伤的阈值。
DOI：
10.1089/end.2010.0648
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发表时间：
2011
影响因子：
2.7
通讯作者：
Roberts,WilliamW
中科院分区：
文献类型：
--
作者：
Styn,Nicholas;Hall,TimothyL;Fowlkes,JBrian;Cain,CharlesA;Roberts,WilliamW
背景和目的：组织摧毁术是一种非侵入性的脉冲超声技术，可在目标体积内产生机械均质化组织。先前的工作已经证明了犬模型中的前列腺组织减积。目的是建立安全阈值，通过评估组织学变化的尿道括约肌，神经血管束（NVB），直肠后，有针对性的histotripsy治疗这些关键structures.Materials和Methods：直肠，尿道括约肌，和NVB在5麻醉犬有针对性的histotripsy治疗（50总分）。位置以500 Hz的重复频率接收1k、10k或100k声脉冲（4微秒，1 MHz）。犬受试者在给药后立即（2）、存活3天（1）或2周（3）实施安乐死。前列腺，前列腺周围组织，和直肠收获和处理histologic.Results：括约肌结构完整，即使在100K脉冲（n=10）最小的肌纤维中断。尽管周围疏松结缔组织机械均质化，但NVB的神经、动脉和静脉未受损（n=19）。然而，直肠表现出剂量依赖性损伤（n=20）。1k脉冲导致轻度粘膜下出血。10k脉冲导致中度胶原破坏和局灶性粘膜均质化。100k脉冲对粘膜和固有肌层产生损伤，伴有广泛出血和胶原破坏。一只狗治疗100K脉冲需要早期安乐死（第3天），因为并发症从尿leak.Conclusions：Histotripsy组织学组织效果不同的基础上有针对性的结构与大量的结构保存NVB和括约肌。直肠亚临床损伤在1k脉冲后明显，并且随着剂量的增加，其程度和严重程度增加。未来的工作将包括评估功能结局和完善这些初始安全阈值。
Background and Purpose:Histotripsy is a noninvasive, pulsed ultrasound technology that produces mechanically homogenized tissue within targeted volumes. Previous work has demonstrated prostatic tissue debulking in a canine model. The aim was to establish safety thresholds by evaluating histologic changes of urinary sphincter, neurovascular bundle (NVB), and rectum after targeted histotripsy treatment of these critical structures.Materials and Methods:Rectum, urinary sphincter, and NVB in five anesthetized canines were targeted for histotripsy treatment (50 total points). Locations received 1k, 10k, or 100k acoustic pulses (4 microsecond, 1 MHz) at a repetition frequency of 500 Hz. Canine subjects were euthanized immediately (2), survived 3 days (1), or 2 weeks (3) after treatment. Prostates, periprostatic tissue, and rectum were harvested and processed for histology.Results:The sphincter was structurally intact with minimal muscle fiber disruption even after 100k pulses (n=10). Undamaged nerves, arteries, and veins of the NVB were seen despite mechanical homogenization of surrounding loose connective tissue (n=19). The rectum, however, exhibited dose-dependent damage (n=20). 1k pulses yielded mild submucosal hemorrhage. 10k pulses resulted in moderate collagen disruption and focal mucosal homogenization. 100k pulses produced damage to the mucosa and muscularis propria with extensive hemorrhage and collagen disruption. One canine treated with 100k pulses needed early euthanasia (day 3) because of complications from a urine leak.Conclusions:Histotripsy histologic tissue effect varied based on targeted structure with substantial structural preservation of NVB and sphincter. Rectal subclinical damage was apparent after 1k pulses and increased in extent and severity with escalating doses. Future work will include assessment of functional outcomes and refinement of these initial safety thresholds.