超声引导下腹腔神经丛阻滞术治疗顽固癌性腹痛  

Ultrasound-guided percutaneous neurolytic celiac plexus block in treatment of intractable carcinomatous abdominal pain

作　　者：史昌乾 张硕[2] 廖威[2] 朱江[2] 赵岩[2] 

机构地区：[1]武警辽宁总队大连分院,110016 [2]武警辽宁总队医院,沈阳110034

出　　处：《武警医学》2012年第12期1068-1071,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的评价超声引导下淋巴结内腹腔神经丛阻滞术对晚期顽固性癌性腹痛的止痛效果及安全性。方法选取35例后腹膜广泛淋巴结肿大,并融合成团块状的晚期癌症患者,在超声引导下经皮腹前壁穿刺行淋巴结内腹腔神经丛无水乙醇阻滞术,记录患者术后疼痛视觉模拟评分(VAS)、吗啡摄入量和不良反应。结果 35例术后第2、4、8、12周的止痛有效率分别为97.14%、91.18%、84.37%、73.33%,术后不同时间有效率间差异无统计学意义(P>0.05)。术后2～12周患者的疼痛视觉模拟评分(VAS)和吗啡摄入量均显著低于术前,差异有统计学意义(P<0.01)。术中、术后未发生严重并发症。结论对晚期后腹膜广泛淋巴结肿大并融合成团块状的顽固性癌性腹痛患者,采用超声引导下经腹前壁途径淋巴结内腹腔神经丛阻滞疗法,镇痛效果确切,安全性高。Objective To evaluate the effect and safety of ultrasound-guided neurolytic celiac plexus block of metastatic lymph nodes in treatment of intractable carcinomatous abdominal pain.Methods Thirty-five patients with advanced stage cancer were treated with ultrasound-guided neurolytic celiac plexus block through anterior abdominal approach into lymph nodes.All the patients were accompanied by enlarged retroperitoneal lymph nodes and celiac plexus involvement fused into masses.The pain VAS was assessed,oral morphine and complications were recorded.Results At the first 2、4、8、12 weeks after the treatment,35 patients＇ analgesic effective rates were 97.14%,91.18%,84.37%,and 73.33%,respectively.There were no significant differences postoperatively after each time point.Comparing the first 2 weeks to the first 12 weeks postoperatively,the VAS and oral morphine were significantly reduced（P0.01）.No serious complications occurred during perioperative period.Conclusions It is safe and effective to treat the patients suffering from intractable carcinomatous abdominal pain in late stage cancer accompanied by enlarged retroperitoneal lymph nodes and fused into masses by the means of neurolytic celiac plexus block with ultrasound-guided through anterior abdominal approach to lymph nodes.

关 键 词：疼痛 超声 无水乙醇 腹腔神经丛 阻滞术 淋巴结 

分 类 号：R614.4[医药卫生—麻醉学]