CT定位脑立体定向丘脑中央中核毁损治疗癌症顽痛的应用  

The Clinical Application of Brain Stereotaxic Therapy for Chronic Cancerous Pain by Damaging Centro-median Thalamic Nuclei

作　　者：项永生[1] 刘灵慧[1] 陈善成[1] 赖睿佳[1] 杜天明[1] 楮建成[1] 杨俊保[1] 

机构地区：[1]广州暨南大学附属第一医院神经外科,广东广州510632

出　　处：《现代生物医学进展》2009年第10期1907-1908,1919,F0003,共4页Progress in Modern Biomedicine

基　　金：广东省医学科研基金资助项目(A2005356)

摘　　要：目的:探讨CT定位脑立体定向丘脑中央中核毁损治疗癌症顽痛的治疗效果。方法:应用立体定向技术,在CT直接靶点定位下,对62位癌痛顽痛进行双侧的中央中核毁损,采用WHO推荐的10分法评定手术前与术后即时及术后3月的疼痛程度。结果:本组患者术前疼痛评分均在7分以上,术后除2例死亡外,其余均降至0～3分,与术前相比有显著差异(P<0.01)。3个月内追踪观察26例患者疼痛有不同程度的复发,但疼痛评分均≤7分,与术前相比有显著差异(P<0.05)。并发症:颅内靶点出血2例,嗜睡4例,偏瘫3例,尿失禁3例,构音障碍2例,动眼神经麻痹、呃逆感觉异常各1例。经对症处理,绝大多数可以恢复。结论:CT定位立体定向中央中核毁损治疗癌症顽痛,创伤小、疗效可靠,是治疗癌性顽痛较为理想的手术方法。Objective： To explore the clinical application of brain stereotaxic therapy for chronic cancerous pain by damaging centro-median thalamic nuclei. Methods： After locating centro-median thalamic nuclei directly by CT with stereotaxic system, the targets were damaged in 62 cases. The pain scores were evaluated before and after operation, and after 3-month follow-up respectively according to the 10 grade method recommended by WHO. Results The pain score of this group was above 7 before operation. After operation, except 2 cases of death, it was decreased to 0-3. So the pain score after treatment was significantly lower than before （P〈0.01）. After 3-month follow-up, the pain reoccurred in 26 cases at different degree, but the pain score was lower than or equal to 7, and compared with that before the operation, there was significant difference （P〈0.05）. Complications： 2 cases had intracranial hemorrhage of target, 4 sleepiness,3 hemiplegia,3 urinary incontinence, 2 dysarthria, 1 oculomotor nerve palsy and 1 abnormal sensation of hiccup. Most of them recovered to normal after the treatment. Conclusion： Because it is easy to operate, and there are fewer complications and less injury to the brain, stereotaxic therapy is an effective method to treat cancer pain.

关 键 词：CT定位 立体定向 中央中核毁损术 癌痛 

分 类 号：R745.11[医药卫生—神经病学与精神病学]