Article(id=1322929496462066051, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.15.025, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1765814400000, receivedDateStr=2025-12-16, revisedDate=1782835200000, revisedDateStr=2026-07-01, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340570798, onlineDateStr=2026-10-30, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340570798, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340570798, creator=13701087609, updateTime=1793340570798, updator=13701087609, issue=Issue{id=1322929431592972373, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='15', pageStart='2577', pageEnd='2768', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340555332, creator='13701087609', updateTime=1793343107287, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940135335145743, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940135335145744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2753, endPage=2757, ext={EN=ArticleExt(id=1322929497888129412, articleId=1322929496462066051, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Application progress on deep hyperthermia for the treatment of colorectal cancer, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This study reviewed the mechanisms,current clinical applications,efficacy evaluation,and adverse reaction management of deep hyperthermia in the treatment of colorectal cancer,so as to provide reference for optimizing patient treatment plans and to improve their quality of life.

, authors=Si WU1, Gaoming LIU2, Jiali XU1, Jiaxuan ZHOU3, Ying YU3, Fangfang JI1, authorsList=Si WU, Gaoming LIU, Jiali XU, Jiaxuan ZHOU, Ying YU, Fangfang JI, authorCompany=null, correspAuthors=Gaoming LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322929498278199685, articleId=1322929496462066051, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=深部热疗在结直肠癌治疗中的应用进展, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

对深部热疗在结直肠癌治疗中的作用机制、临床应用现状、疗效评估及不良反应管理等方面进行综述,旨在为优化病人治疗方案、提高病人生存质量提供参考。

, authors=吴驷1, 刘高明2, *, *, 许佳丽1, 周佳璇3, 喻映3, 吉芳芳1, authorsList=吴驷, 刘高明, 许佳丽, 周佳璇, 喻映, 吉芳芳, authorCompany=null, correspAuthors=刘高明, authorNote=

吴驷,主管护师,硕士研究生在读

, correspAuthorsNote=
刘高明,E-mail:
LIU Gaoming, E-mail:
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吴驷,主管护师,硕士研究生在读

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吴驷,主管护师,硕士研究生在读

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深部热疗在结直肠癌治疗中的应用进展
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吴驷 1 , 刘高明 2, *, * , 许佳丽 1 , 周佳璇 3 , 喻映 3 , 吉芳芳 1
护理研究 | 科研综述 2026,40(15): 2753-2757
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护理研究 |科研综述 2026 , 40 (15) : 2753 -2757
深部热疗在结直肠癌治疗中的应用进展
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吴驷1, 刘高明2, *, * , 许佳丽1, 周佳璇3, 喻映3, 吉芳芳1
作者信息
  • 1中南大学湘雅护理学院,湖南 410013
  • 2湖南省肿瘤医院
  • 3湖南中医药大学
通讯作者:
刘高明,E-mail:
LIU Gaoming, E-mail:
作者简介:

吴驷,主管护师,硕士研究生在读

Application progress on deep hyperthermia for the treatment of colorectal cancer
Si WU1, Gaoming LIU2 , Jiali XU1, Jiaxuan ZHOU3, Ying YU3, Fangfang JI1
Affiliations
  • 1Xiangya School of Nursing, Central South University, Hunan 410013 China
  • 2Hunan Cancer Hospital
  • 3Hunan University of Chinese Medicine
出版时间: 2026-08-10 doi: 10.12102/j.issn.1009-6493.2026.15.025
文章导航
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对深部热疗在结直肠癌治疗中的作用机制、临床应用现状、疗效评估及不良反应管理等方面进行综述,旨在为优化病人治疗方案、提高病人生存质量提供参考。

结直肠癌  /  深部热疗  /  肿瘤治疗  /  联合治疗  /  综述

This study reviewed the mechanisms,current clinical applications,efficacy evaluation,and adverse reaction management of deep hyperthermia in the treatment of colorectal cancer,so as to provide reference for optimizing patient treatment plans and to improve their quality of life.

colorectal cancer  /  deep hyperthermia  /  cancer treatment  /  combination therapy  /  review
吴驷, 刘高明, 许佳丽, 周佳璇, 喻映, 吉芳芳. 深部热疗在结直肠癌治疗中的应用进展. 护理研究, 2026 , 40 (15) : 2753 -2757 . DOI: 10.12102/j.issn.1009-6493.2026.15.025
Si WU, Gaoming LIU, Jiali XU, Jiaxuan ZHOU, Ying YU, Fangfang JI. Application progress on deep hyperthermia for the treatment of colorectal cancer[J]. Chinese Nursing Research, 2026 , 40 (15) : 2753 -2757 . DOI: 10.12102/j.issn.1009-6493.2026.15.025
结直肠癌是全球发病率和死亡率均较高的恶性肿瘤之一,2022年全球新发病例超192万例,死亡病例超90万例[1],对公共卫生系统构成严峻挑战[2]。结直肠癌传统的治疗方法主要包括手术、放疗和化疗等,但这些方法在应对晚期结直肠癌时效果有限,且常伴有较高的复发率和不良反应[3]。热疗是一种借助物理能量在肿瘤局部产生热量,从而选择性杀伤癌细胞并最大限度保护正常组织的治疗方法。根据作用范围可分为全身热疗与局部热疗。深部热疗(deep hyperthermia)作为局部热疗的一种重要形式,目前已应用于包括结直肠癌在内的多种实体瘤治疗,其不仅可直接诱导肿瘤细胞凋亡[4],还可作为联合治疗的增敏剂,增强抗肿瘤效果,改善病人生存预后,且未明显增加治疗相关不良反应[5]。近年来,随着热疗技术的不断进步和临床证据的积累,深部热疗在结直肠癌治疗中的作用日益受到重视。然而,深部热疗在结直肠癌治疗中的机制、治疗参数标准化及长期疗效评估方面仍存在争议。因此,本研究系统综述深部热疗在结直肠癌治疗中的研究现状,为优化治疗方案、提高病人生存质量提供参考。
深部热疗是一种基于物理升温的肿瘤治疗技术,其基本原理是通过热能增强对肿瘤细胞的杀伤效果[6]。根据能量传递方式差异可分为射频热疗、微波热疗、磁感应热疗及超声热疗4类。射频热疗利用高频电磁波可在深部组织(如腹腔、盆腔等)中产热,适用于深部肿瘤;微波热疗可通过微波实现浅表及部分深部肿瘤的加热;磁感应热疗则借助磁性纳米颗粒在交变磁场中的磁滞损耗,实现对局部深部肿瘤的控温治疗[7];超声热疗可利用高强度聚焦超声(high intensity focused ultrasound,HIFU)精准靶向肝、胰等局灶实体瘤[8]。
深部热疗主要从肿瘤细胞、肿瘤微环境(tumor microenvironment,TME)及系统免疫3个层面协同发挥抗肿瘤作用。在细胞层面,诸多抗肿瘤治疗方案均借助诱导肿瘤细胞凋亡实现功效[9]。研究表明,高温可诱导肿瘤细胞发生凋亡,其机制包括激活死亡受体通路[10]、引发内质网应激反应[11-12]及脱氧核糖核酸(DNA)/核糖核酸(RNA)损伤后启动抑癌基因p53介导的凋亡程序[13]等。在肿瘤微环境层面,热疗不仅能够改善肿瘤组织的血流灌注,促进化疗药物的输送与渗透[14],还可通过调节免疫抑制性微环境,增强T细胞和自然杀伤细胞(NK)等免疫细胞的浸润功能,从而提高对肿瘤细胞的识别与清除能力[15]。在系统免疫层面,热疗可在适宜治疗条件下,诱导肿瘤细胞发生免疫原性细胞死亡或释放免疫刺激性损伤相关分子模式,促进树突状细胞成熟并增强其抗原提取与呈现功能,从而激活后续抗肿瘤免疫应答[16]。此外,热疗还可与免疫检查点抑制剂等治疗方法协同,显著增强抗肿瘤免疫应答[17-18]。综上所述,深部热疗通过上述多层次、多机制的生物学效应,在结直肠癌治疗中展现出重要的应用潜力,未来研究应致力于优化其与现有治疗手段的联合应用策略,以期进一步提升临床疗效和病人生存质量。
深部热疗作为一种独立的治疗手段,近年来在结直肠癌治疗中引起了广泛关注,其可以通过多种机制(如促进肿瘤细胞程序性死亡、抑制肿瘤细胞增殖速率及改善肿瘤微环境中的血液循环和氧气供应等)发挥抗肿瘤作用,从而提高治疗效果[19]。研究发现,对结直肠癌病人单独应用热疗能够改善其生活质量,并在一定程度上减轻肿瘤负担[20]。然而,热疗效果往往受肿瘤位置、大小及病人个体差异等因素影响[21]。因此,在临床中应用需结合具体情况进行个性化调整。
深部热疗联合放化疗可增强结直肠癌治疗效果。研究表明,热疗可作为放化疗的辅助治疗方法,通过提高肿瘤细胞的温度抑制其DNA修复机制,并影响其生存能力,旨在提升其对放射线及化疗药物的敏感性以增强整体治疗效果[22]。一项研究也发现,联合深部热疗的放化疗方案能提高结直肠癌病人的疾病控制率,延长生存期[23],但具体方案和实施方式还需根据病人的实际情况进行调整,以确保最佳的治疗效果。
深部热疗联合靶向治疗在结直肠癌治疗中展现出显著的协同效应。靶向治疗虽具有高特异性和较低毒副作用等优势,但仍面临治疗反应率有限、易产生耐药性以及成本高昂并依赖特定生物标志物等局限[24]。而深部热疗可从多途径增强靶向治疗效果:其一,热疗可提高肿瘤组织的血流灌注和血管通透性,促进靶向药物的渗透与分布,从而提升其局部浓度[25];其二,热疗可诱导肿瘤细胞发生免疫原性死亡,释放肿瘤抗原,激活机体抗肿瘤免疫应答,从而协同增强靶向疗效[26];其三,热疗可调控肿瘤微环境,通过抑制肿瘤细胞代谢外排功能等方式降低其耐药性,进而提高靶向药物的杀伤敏感性[27]。在临床研究中,深部热疗联合靶向治疗已展现出良好的应用前景,尤其是在对抗耐药性肿瘤方面效果更加显著[28]。
深部热疗联合免疫治疗可产生协同抗肿瘤效应,在预防癌症复发转移、延长病人生存期方面展现出潜力[29]。一方面,热疗可通过诱导肿瘤细胞发生免疫原性死亡、改善肿瘤微环境的氧合状态等方式,增强免疫细胞的功能,促进免疫系统对肿瘤的识别和攻击,从而增强免疫治疗的效果[30-31]。另一方面,热疗可为免疫治疗提供有利的环境。研究发现,经过热疗后,肿瘤微环境中的免疫细胞浸润上升,肿瘤细胞表面的免疫检查点分子的表达水平也发生变化,这为免疫治疗提供了更为有利的条件[32]。这种联合治疗策略在临床中展现出良好前景,未来可能成为治疗结直肠癌的重要组成部分。
综上所述,深部热疗在结直肠癌的临床应用中展现出了良好的前景,尤其是当与放疗、化疗、靶向治疗和免疫治疗联合使用时,能够显著增强治疗效果并改善病人的生活质量。未来的研究应继续探索热疗的最佳应用方案,以实现更好的临床效果。
在评估深部热疗治疗结直肠癌的临床疗效时,通常采用一系列标准化指标,主要包括客观缓解率(objective response rate,ORR)、疾病控制率(disease control rate,DCR)、总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)及Karnofsky功能状态评分(Karnofsky Performance Status,KPS)[33]。其中,客观缓解率指肿瘤体积缩小达到预定标准的病人比例;疾病控制率则包括达到完全缓解、部分缓解和疾病稳定的病人比例[34];总生存期和无进展生存期是评估长期疗效的重要指标,通常通过随访病人的生存时间和疾病进展情况获得[35]。此外,KPS评分能有效反映病人的整体身体功能状态和日常生活自理能力,对于全面衡量治疗获益与风险至关重要[36]。近年来,随着深部热疗技术的进步,结合化疗或靶向治疗等的联合疗法也逐渐成为研究热点,结合上述指标进行综合评估能更全面地评价治疗方案的有效性和安全性[37]。
多项临床研究已证实了深部热疗在结直肠癌治疗中的疗效。例如,Ranieri等[15]研究显示,深部热疗联合贝伐珠单抗和FOLFOX-4方案可显著提高病人疾病控制率,在90 d时评估该值高达95%。此外,Han等[38]研究显示,深部热疗能有效降低肿瘤标志物水平,联合深部热疗组在治疗后血清癌胚抗原(carcinoembryonic antigen,CEA)和血管内皮生长因子(vascular epidermal growth factor,VEGF)水平低于对照组,生活质量评分提高,表明深部热疗有助于提升抗肿瘤效果和病人生存质量。另一项研究聚焦转移性结肠癌,结果表明,深部电热疗法联合化疗安全性良好,且未观察到严重不良反应,验证了其临床应用的可能性[39]。这些研究结果为深部热疗作为结直肠癌辅助治疗手段提供了有力的临床依据。未来研究需通过大样本、多中心临床试验进一步验证其长期疗效,并探索不同治疗组合的最佳方案,以期提高结直肠癌病人的治疗效果和生存率[40-41]。
不良反应评估是确保深部热疗安全性的关键环节。目前,主要采用的评估标准有世界卫生组织-乌普萨拉监测中心(World Health Organization-Uppsala Monitoring Centre,WHO-UMC)量表和Naranjo算法,这2种方法在药物不良反应评估中得到了广泛应用。WHO-UMC标准提供了一种简化的评估工具,能够快速判断不良反应与药物之间的因果关系,而Naranjo算法则可通过一系列问题量化因果关系的强度[42]。此外,临床医生还可以使用药物不良反应严重程度评估量表(Adverse Drug Reaction Severity Assessment Scale,ADRSAS)评估不良反应的严重程度,以帮助制定相应的管理策略[41]。而在深部热疗的临床应用中,评估工具的选择应考虑病人的具体情况和治疗方案。例如,对于接受联合治疗的病人,可以通过监测血液生化指标、影像学检查和病人的主观症状综合评估不良反应及其严重程度[20]。此外,数字化工具和人工智能的应用也为不良反应的评估提供了新的可能性,这些工具能够实时监测病人的健康状况,并及时反馈不良反应的风险[43]。
深部热疗的常见不良反应主要包括皮肤反应、疼痛、发热、乏力和胃肠道反应等。皮肤反应是最常见的副作用之一,通常表现为局部红肿和水疱,尤其是在高温处理后,皮肤耐受性较差的病人更容易出现此类反应[44]。疼痛的发生则可能与肿瘤本身的疼痛感受性及热疗过程中的温度变化有关,部分病人在接受深部热疗后报告疼痛加剧[20]。此外,发热和乏力也是常见的全身反应,通常与体内炎症反应相关[43]。而胃肠道反应主要表现为恶心、呕吐及腹泻等,可能与热疗对胃肠道组织的直接影响及与化疗药物的联合使用有关[20]。研究显示,深部热疗与化疗联合应用时,尤其是接受氟尿嘧啶、顺铂等化疗药物,病人的胃肠道反应发生率显著升高[44]。
深部热疗引发不良反应的生理机制主要与热对细胞和组织的影响有关。高温可导致细胞膜破坏、蛋白质变性及细胞内代谢改变,从而引发局部和全身的炎症反应[45]。一方面,热疗可激活机体免疫反应,导致细胞因子释放,这些因子在一定程度上会引发炎症反应,进而导致皮肤红肿和疼痛[46]。另一方面,热疗还可能影响血液循环,导致局部血流量增加,进一步加重局部不适感[47]。对于某些病人而言,热疗的强度和持续时间也会影响不良反应的发生率,过高的温度或过长的治疗时间可能导致更严重的副作用[38]。
针对热疗的不良反应,临床上可采取多种管理策略。针对局部皮肤反应,可在治疗前后对治疗区域进行适当的护理,如使用保湿剂和抗炎药物,以减轻皮肤的不适感[48]。针对疲劳和疼痛,可通过适度休息和疼痛管理(如使用非甾体抗炎药物)缓解症状。此外,保持充足的水分摄入和营养支持也有助于改善病人的整体状态和耐受性[49]。在体温管理方面,医务人员应密切监测病人的体温变化,特别是在高温治疗期间,如果病人体温超过38.5 ℃,应及时采取降温措施,如使用冷敷或药物降温,以防止热射病的发生[50]。因此,热疗前应对病人进行全面的健康评估,以识别潜在的高风险因素(如心血管疾病或其他影响耐热能力的疾病),并制定相应的预防措施[51]。
除此之外,在接受深部热疗时,病人的自我管理也至关重要。通过在治疗前向病人宣教热疗的相关信息(包括可能出现的不良反应及其应对措施、治疗期间需维持的健康生活方式等),增强其对治疗过程的理解,减轻焦虑,提高治疗依从性、机体免疫力及恢复力。另外,病人应定期监测自身的体温变化,及时向医务人员报告任何异常情况,如出现持续高热或明显的皮肤反应,以便及时调整治疗方案[52]。最后,在接受热疗期间应保持良好的心理状态,必要时可寻求心理支持或参加相关支持小组,以帮助病人更好地应对治疗带来的压力和不适感。上述自我管理措施不仅可提高病人对热疗的耐受性,还可在一定程度上改善其治疗效果和生活质量[51]。
目前,深部热疗在结直肠癌治疗中展现出良好前景,通过诱导肿瘤细胞凋亡、影响肿瘤微环境及增强免疫应答等多重机制,与放化疗、靶向及免疫治疗等具有较好的协同效应。然而,该技术在临床应用中仍面临诸多挑战,如其最佳应用方案和长期疗效及安全性尚待明确、疗效评估标准化不一等。未来研究应深入探索深部热疗的作用机制,制订标准化实施流程及统一评估标准,并关注病人的个体化差异及疾病进展情况,建立个性化治疗方案,进一步优化不良反应管理策略,以确保病人获得安全有效的治疗。

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2026年第40卷第15期
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doi: 10.12102/j.issn.1009-6493.2026.15.025
  • 接收时间:2025-12-16
  • 首发时间:2026-10-30
  • 出版时间:2026-08-10
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  • 收稿日期:2025-12-16
  • 修回日期:2026-07-01
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    1中南大学湘雅护理学院,湖南 410013
    2湖南省肿瘤医院
    3湖南中医药大学

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2种不同金属材料的力学参数
科
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属数
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genus
种数
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species
占总种数比例
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total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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