腹腔神经丛联合上腹下神经丛阻滞对顽固性腹部和(或)盆腔癌痛的作用  

Combined Neurolytic Block of Celiac and Superior Hypogastric Plexuses for Incapacitating Abdominal and/or Pelvic Pain

作　　者：黄丽霞[1,2] 曲丕盛[1,2] 王振[1,2] 万海方[1,2] 陶凡[1,2] 郑汉光[1,2] 

机构地区：[1]浙江省中西医结合医院 [2]杭州市红十字会医院麻醉疼痛科,杭州310003

出　　处：《中国中西医结合外科杂志》2009年第6期587-590,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：浙江省医药卫生科学研究基金(2008B153)

摘　　要：目的:评价腹腔神经丛联合上腹下神经丛阻滞对晚期腹部和(或)盆腔恶性肿瘤并发顽固性腹部和(或)盆腔内脏痛患者的镇痛效果。方法:对45例患者,在CT引导下后路经椎间盘旁法穿刺,用90%乙醇作为毁损剂,同时行腹腔丛和上腹下神经丛毁损术。观察毁损前和毁损后24h、1周、1个月和3个月各时段的疼痛VAS评分、吗啡控释片日用量和生活质量(QOL)评分、并发症和副作用。结果:与毁损前比较,毁损后各时段VAS评分和吗啡控释片日用量均明显降低(P<0.05),有13例镇痛效果满意直至去世;与术前比较,毁损后24h、1周、1个月QOL评分明显升高(P<0.05),第3个月时QOL评分无明显差异(P>0.05),未发生严重并发症和副作用。结论:在CT引导下以90%乙醇行腹腔丛联合上腹下神经丛毁损术可有效减轻晚期腹、盆腔癌症患者疼痛,减少吗啡日用量,从而提高患者的生活质量。Objective To assess the therapeutic effect of combining neurolytic block of celiac and superior hypogastric plexuses for incapacitating abdominal and/or pelvic cancer pain.Methods Forty-five patients with extensive abdominal or pelvic cancer who suffered uncontrolled,diffuse,extensive and incapacitating pain were treated with a combination of neurolytic celiac plexus block （CPB） and superior hypogastric plexus block （SHGPB）.Combined neurolytic CPB and SHGPB was performed with alcohol,mainly using a transintervertebral disc approach.Visual analog scale （VAS） pain scores,daily morphine consumption,the quality of life （QOL） scores and side effects were recorded. Results The combined neurolytic block produced effective pain relief almost in all patients after 24 hours （VAS reduced from 8.9±0.4 to 0.5±0.3）.This pain relief persisted during the first 3 months （VAS,2.5±0.4） or until death.Morphine consumption was significantly decreased after the neurolysis.The QOL also improved significantly during the first month （from 40±6 to 59±6）.No serious complications caused by the neurolytic procedure have been observed. Conclusion Combined neurolytic CPB and SHGPB improves the quality of life of patients with incapacitating cancer pain,by reducing both the intensity of pain and opioid consumption,hence providing a new and more effective therapeutic option for pain relief in patients with advanced cancer.

关 键 词：神经毁损术 腹腔神经丛 上腹下神经丛 顽固性癌痛 

分 类 号：R246.2[医药卫生—针灸推拿学]