A Research of Treatment for urinary bladder tumor using ultrasound-tomography under cystoscipy

摘要本研究的目的是：(1)将微型超声探头与膀胱镜相结合，同时描绘肿瘤的超声图像与内镜图像，从而获得高精度的诊断能力；(2)利用超声有效地治疗肿瘤部位。对26例经内窥镜等检查已确诊为膀胱肿瘤的患者，将25f刚性膀胱镜置入膀胱，在视频监控下扫描肿瘤，微型超声探头从膀胱镜钳口插入。此外，这样布置可以使内窥镜图像和超声图像并排放置观察。因此，我们发现微型超声探头的优势在于，在确定肿瘤的同时可以在内镜下进行扫描，因此可以更合适地选择扫描平面和更安全地接近肿瘤。此外，该探针能够比老式探针更清楚地观察到10个小肿瘤。该结果提示了微型探头超声内窥镜诊断/治疗膀胱肿瘤的可能性。预计微型探针的进一步小型化将使这种诊断/治疗技术不仅可以应用于膀胱，还可以应用于上尿路，并且通过将该技术与超声波和冲击波疗法相结合，可以对患者进行更准确和更少侵入性的治疗。研究了高能冲击波（HESW）联合抗癌药物治疗小鼠膀胱癌MBT-2肿瘤的作用。为了获得HESW单独抗肿瘤的显著效果，需要19 kv 5000针，HESW 5000针与CDDP 1 u/ml联合作用。以上结果强烈提示冲击波联合目前用于治疗尿石症和胆石症的抗癌药物治疗有可能在未来成为包括膀胱肿瘤在内的多种癌症的多学科治疗方法之一。少

AbstractThe aim of this study is (1) to depict the ultra-sonographic images of tumor simultaneously with the endoscopic images by combining a miniature ultrasound probe with cystoscope, thereby obtaining a diagnostic ability of high precission and (2) to effeciently treat the site of tumor by using ultrasonic waves.1.For 26 patients who were already diagnosed as having a bladder tumor by endoscopic examination, etc., a 25 Fr.rigid cystoscope was introduced into the bladder, and scanning was done while observing the tumor under video monitoring with a miniature ultrasound probe inserted from the mouth of forcepts of cystoscope.Furthermore, it was so arranged that the endoscopic image and the ultrasonographic image can be placed side by side for observation. As a result, the miniture ultrasound probe was found to be advantageous in that more appropriate selection of the scanning plane and safer approach to the tumor can be made since scanning can be done while confirming the tumor under … More an endoscope.Further, this probe was able to visualize enen small tumors more clealy than the old type probe. This result indicates the possibility of development to the diagnosis/treatment of bladder tumor with an ultrasound endoscope using a miniature probe. It is expected that further miniaturization of the miniature probe will enable this diagnostic/therapeutic technique to be applied not only to the bladder but also to the upper urinary tract and also that more accurate and less invasive treatment to the patients will be made possible by a combinational use of this technique and therapies using ultrasonic waves and shock waves.2. Combined effects of the high energy shock wave (HESW) and anti-cancer drugs were studied with mouse bladder cancer MBT-2 tumor. In order to obtain a significant anti-tumor effect with HESW alone, 19 kv 5000 shots were required, and combined effects of HESW 5000 shots and CDDP 1 u/ml were recognized.The results above strongly suggest the possibility that combined therapy with shock waves and anti-cancer drugs currently in use for the treatment of urolithiasis and cholelithiasis will make a grate stride as one of the multidisciplinary therapies for cancers including bladder tumor in the future. Less