Histotripsy for Urinary Stone Comminution

尿路结石粉碎的组织解剖学

• 批准号: 8333369
• 负责人: Timothy L Hall
• 金额: $ 38.48万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8333369
• 关键词: Ablation; Acoustics; American; Area; Calculi; Caliber; Cell membrane; Cystine; Dose; Effectiveness; Environment; Generations; Goals; Injury; Intervention; Kidney; Lithotripsy; Methods; Microbubbles; Microscopic; Outcome; Pain; Patients; Procedures; Process; Pump; Research; Risk; Surface; Techniques; Tissues; Treatment outcome; Ultrasonic Therapy; Ultrasonography; Ureter; Urinary Calculi; follow-up; improved; particle; soft tissue; sound; success; time use; tool

DESCRIPTION: The overall goal of this proposal is to develop a new process for more complete comminution of urinary calculi (stones) by combining histotripsy acoustic fields with conventional shockwaves. Preliminary evidence shows that histotripsy and lithotripsy can operate synergistically in multiple ways to enhance stone fragmentation. Histotripsy ultrasound therapy is a method of soft tissue ablation where extremely intense acoustic bursts cause microscopic bubbles to form and collapse energetically (cavitation) disrupting cell membranes and fragmenting nearby tissues. Using short bursts up to a few tens of acoustic cycles and highly focused sound fields allows cavitation to be controlled for precise ablation. Histotripsy research has yielded a greater understanding of acoustically generated cavitation and techniques for the enhancement and suppression of cavitation activity, which have been employed to increase the ablation rate and to protect adjacent tissue from collateral injury. When applied directly to stones, histotripsy produces rapid surface erosion with the generation of only microscopic debris. In combination with shockwaves, cavitation amplifying histotripsy sequences are expected to enhance stone comminution while suppressing sequences will "actively protect" surrounding kidney parenchyma from damage. While shockwave lithotripsy (SWL) has been an invaluable tool in the treatment of urinary stones, success rates have been consistently worse than more invasive interventions. SWL fails to achieve stone free status in 20-40% of patients at 3 month follow up and even "successful" procedures may involve the painful passage of fragments which have been only partially disintegrated. Large stones (> 20 mm diameter), stones of difficult composition (i.e. cystine), and stones located in the lower pole all have worse outcomes further discouraging treatment with SWL. Using histotripsy to control the cavitation environment immediately near a stone and in neighboring tissues allows a decoupling of cavitational and non-cavitational SWL mechanisms otherwise closely intertwined. This will aid in their study and optimization ultimately leading to more efficient stone comminution strategies producing better treatment outcomes and opening up traditionally difficult stones to the option of SWL.

描述：该提案的总体目标是通过将组织解剖声场与传统冲击波相结合，开发一种更彻底粉碎泌尿系结石的新工艺。初步证据表明，组织碎石术和碎石术可以多种方式协同作用，以增强结石破碎。 组织解剖超声治疗是一种软组织消融方法，其中极其强烈的声爆发导致微小气泡形成并剧烈破裂（空化），破坏细胞膜并使附近组织破碎。使用长达几十个声学周期的短脉冲和高度聚焦的声场可以控制空化以实现精确的消融。组织解剖学研究对声学产生的空化以及增强和抑制空化活动的技术有了更深入的了解，这些技术已被用来提高消融率并保护邻近组织免受附带损伤。 当直接应用于结石时，组织解剖会产生快速的表面侵蚀，仅产生微小的碎片。与冲击波相结合，空化放大组织解剖序列预计将增强结石粉碎，而抑制序列将“积极保护”周围的肾实质免受损伤。 虽然冲击波碎石术 (SWL) 一直是治疗尿路结石的宝贵工具，但成功率一直低于更具侵入性的干预措施。在 3 个月的随访中，20-40% 的患者在 SWL 中未能达到无结石状态，即使“成功”的手术也可能涉及仅部分分解的碎片的痛苦通过。大结石（直径 > 20 毫米）、成分困难的结石（即胱氨酸）和位于下极的结石均具有更差的结果，进一步阻碍了 SWL 治疗。 使用组织解剖学来控制结石附近和邻近组织中的空化环境，可以将空化和非空化 SWL 机制解耦，否则它们会紧密地交织在一起。这将有助于他们的研究和优化，最终导致更有效的结石粉碎策略，从而产生更好的治疗效果，并为传统上难以处理的结石提供了 SWL 的选择。