CT引导下腹腔神经丛阻滞术治疗癌性腹痛(附132例报道)  

CT-guided neurolytic celiac plexus block in control of abdominal cancer pain (a report of 132 cases)

作　　者：童国海[1] 乔中伟[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,上海200025

出　　处：《外科理论与实践》2007年第5期491-495,共5页Journal of Surgery Concepts & Practice

摘　　要：目的:评价CT引导下腹腔神经丛阻滞(NCPB)术治疗癌性腹痛的疗效,比较不同肿瘤和不同进针途径对疗效的影响。方法:分析经CT引导下注射无水乙醇进行NCPB术治疗胰腺癌、肝(胆)癌和胃癌等晚期肿瘤导致的顽固性腹痛共132例。对于术后止痛效果进行1周～3个月的评价,评价方法采用4分制法,判断NCPB术的治疗效果。结果:经腹前壁途径NCPB术治疗胰腺癌43例、肝(胆)癌32例、胃癌22例,其术后1周和3个月有效率分别为95.4%、90.7%;84.4%、75.0%和100.0%、77.3%。经脊柱旁途径治疗胰腺癌19例、肝(胆)癌13例、胃癌3例,其术后1周和3个月有效率分别为89.5%、89.5%;76.9%、61.5%和100.0%、66.7%。NCPB治疗不同肿瘤的长期总有效率是81.1%,胰腺癌、肝(胆)癌和胃癌分别是:90.3%、71.1%、76.0%。不同肿瘤之间有效率有显著差异。两种不同途径NCPB之间长期疗效分别为82.5%、77.1%,无显著差异。结论:对不同肿瘤的NCPB治疗效果相比,胰腺癌的长期疗效最佳。前路进针的NCPB术定位准确,无水乙醇弥散程度好,但长期治疗效果和后路进针无显著差异。Objective To evaluate the therapeutic effect of CT-guided neurolytic celiac plexus block （NCPB） in control of cancer-caused abdominal pain. Methods To analyze 132 cases of patients suffering intractable abdominal pain by different cancers, including pancreatic carcinoma, hepatoeellular carcinoma and gastric carcinoma, through CT-guided injection of dehydrated alcohol into the celiac plexus. We evaluate the therapeutic effect of NCPB by recording the score of pain relief a week to three months after the procedure. Results The effective rate of pain relief a week and three months after the procedure for different cancers and by different route of NCPB are as following： the group by anterior abdominal approach, and the group by posterior dorsal paraspinal approach, treating pancreatic carcinoma （19cases; 89.5%; 89.5%）, hepatic cellular cancer（13cases; 76.9%; 61.5%）, gastric cancer （3cases; 100.0%; 66.7%）. Gathering the data of cases taking the anterior or the posterior routes, the effects of NCPB three months after the procedure for different cancers were as follows： pancreatic carcinoma 90.3%, hepatocellular carcinoma 71.1%, gastric carcinoma 76.0%; the difference between them was significant. The effect three months after the procedure for different routes was 82.5% and 77.1%; the difference between them was not significant. Conclusion CT-gnided NCPB is a safe and effective method to control the cancer-caused intractable abdominal pain. The therapeutic effect for pancreatic carcinoma is better than for hepatocellular and gastric carcinomas. The effect of different approaches of NCPB is slightly different but not significant, and the anterior approach is somewhat better than the posterior one.

关 键 词：癌 腹痛 腹腔神经丛阻滞术 体层摄影术 X线计算机 

分 类 号：R735[医药卫生—肿瘤]