不同穿刺途径腹腔神经丛阻滞术治疗癌性腹痛比较.docVIP

不同穿刺途径腹腔神经丛阻滞术治疗癌性腹痛比较 　【摘要】 　　目的 比较不同穿刺途径腹腔神经丛阻滞术(PNCPB)对晚期癌痛的疗效。方法 将常规止痛治疗无效的51例晚期癌性疼痛患者分为2组，椎旁入路组36例，椎间盘入路组15例，缓慢注入95%无水乙醇约30 ml。记录透视时间，用视觉权衡评分法(VAS)评价止痛疗效。结果 所有患者PNCPB均成功，两组所用透视时间无统计学意义(Pgt;0.05)。术后48 h VAS测定，椎旁入路组疼痛缓解总有效率77.8%(28/36)，椎间盘入路组总有效率86.7%(13/15)，差异无统计学意义(P=0.70)；疼痛完全缓解率分别为33.3%(12/36)和73.3%(11/15)，差异有统计学意义(P=0.01)。结论 经椎间盘入路PNCPB治疗癌痛，方法简单安全，效果优于椎旁入路。 【关键词】 神经丛阻滞； 疼痛； 肿瘤 【Abstract】 Objective To evaluate the therapeutic effect of percutaneous neurolytic celiac plexus block (PNCPB) via different approaches in the treatment of refractory upper abdominal pain caused by malignant tumor. Methods 51 patients with intractable upper abdominal pain due to cancer were divided into 2 groups. The transintervertebral disc approach and the posteriorlateral approach were used in 15 cases and 36 cases, respectively. About 30 ml alcohol was used in every patient. The duration of fluoroscopy to complete the procedure was recorded. Visual analogue scales (VAS) was accepted to evaluate the effects in these patients. Results There was not obvious difference of the time of fluoroscopy between two groups. After 48 hours, the total effective rate of pain relief was 33.3% (12/36) in group of posteriorlateral approach and 73.3%(11/15)in group of transintervertebral disc approach. There was obvious difference between two groups. Conclusion The transintervertebral disc approach can be used easily and safely in practice of PNCPB. PNCPB conducted by the approach is more effective than by posteriorlateral approach. 【Key words】 Neurolytic celiac plexus block； Pain； Cancer 胰腺癌、肝癌等肿瘤晚期由于侵犯神经或神经丛可致剧烈腹痛，腹腔神经丛阻滞术(percutaneous neurolytic celiac plexus block，PNCPB)可治疗癌性腹痛［1］。PNCPB的基本入路除椎旁外，还有前腹壁、椎间盘和主动脉入路等［2］，但目前尚无各入路间疗效对比研究报道，本文旨在对经椎旁和椎间盘入路行PNCPB的疗效进行比较。 1 材料与方法 1.1 一般资料 收集2000年3月～2006年5月我院晚期肿瘤患者51例，其中胰腺癌27例，原发性肝癌18例，转移性肝癌6例，均为常规止痛治疗无效者。男33例，女18例，年龄42～78岁，平均53±5.7岁。分为2组，椎旁入路组36例，椎间盘入路组15例，术前行常规检查和碘过敏试验阴性，无手术禁忌证。 1.2 治疗方法 所有患者均在OEC 9800 C形臂血管造影机监视下操作，采用美国Cook公司产22 G Chiba穿刺针。为不影响对阻