经L5／S1小关节内侧缘双针法行上腹下丛神经化学毁损治疗慢性盆腔痛的临床研究  

Using double needle method and passing by L5/S1 internal edge of lumbar facet joint to ablate superior hypogastric plexus for treatment of chronic pelvic pain

作　　者：李晓宏[1] 高崇荣[2] 杨承祥[1] 富沛勇[1] 

机构地区：[1]中山大学附属佛山医院疼痛科,528000 [2]广州医学院第二附属医院疼痛科

出　　处：《国际麻醉学与复苏杂志》2008年第4期298-300,309,共4页International Journal of Anesthesiology and Resuscitation

基　　金：佛山市重点科技攻关项目（项目编号：200708027）

摘　　要：目的探讨一种新的穿刺方法行上腹下丛神经毁损治疗慢性盆腔痛的疗效及安全性。方法15例确诊为子宫内膜异位症的慢性盆腔痛患者，经止痛药物保守治疗失效。患者取俯卧位，在腰椎正位X光下确定L5／S1双侧小关节内侧缘与L5／S1椎间盘，穿刺针经L5／S1双侧小关节内侧缘穿刺，在腰椎侧位X光引导下突破椎间盘，确认针的位置正确无误后双侧总共给予10％酚甘油20ml。分别就手术耗时及治疗后第1天、1月、2月、3月的VAS评分、每日止痛药的需要量、生活质量改善情况及安全性进行评估。结果手术耗时短，平均为（26．3±4．6）min，治疗后患者的疼痛评分较治疗前有明显降低（P〈0．05），止痛药的日需要量较术前明显下降（P〈0．01），生活质量也有显著改善，治疗总有效率与术前单纯药物治疗相比有统计学差异（P〈0．05），有1例患者术后出现便秘，未发现有椎间盘炎、椎间盘破裂及血管、神经损伤等其他严重并发症。结论经小关节内侧缘双针法是一项操作简便、安全，疗效确切、可靠的微创介入治疗方法。Objective To evaluate the efficacy and safety of using double needle method and passing by L5/S1 internal edge of lumbar facet joint to destroying superior hypogastric plexus for treatment of chronic pelvic pain. Methods 15 female cases were chosen who suffered from chronic pelvic pain caused by endometriosis, and could not liberate from pain with conventional therapy. L5/S1 intervertebral disc and internal edge of lumbar facet joint were identified using fluoroscopy at prone position. The needle was then penetrated into the disc and advanced under lateral fluoroscopic control. While the needle position was verified correctly, neurolysis was performed with 20 ml of 10% phenol solution. Spending time for the procedure and the analgesic effect was measured and evaluated, respectively. Results The average spending time for the procedure was （26.3 ± 4.6） min. All patients got significant pain relief immediately after the ablation （P 〈 0.05 ） , and daily consumption of analgesics significantly reduced （ P 〈 0.01 ）. Except constipation occurred in one patient, no other complications such as discitis, disc rupture or nerve injury arose. Conclusion Using double needle method and passing by internal edge of lumbar facet joint to ablate superior hypogastric plexus is an easy, safe and effective therapy with less side effect for relieving chronic pelvic pain from endometriosis.

关 键 词：腰椎小关节 慢性盆腔痛 上腹下神经丛 化学毁损 

分 类 号：R711.71[医药卫生—妇产科学]