超声引导下射频消融治疗痛性神经瘤的疗效  

Efficacy of ultrasound-guided interventional therapy for painful neuroma

作　　者：徐晨婕[1] 高献忠[1] 管华[1] 卜心怡 王亭亭[1] 柳舒扬 陆伟萍[1] 程浩[1] 李陆军[2] 鲍红光[1] XU Chenjie;GAO Xianzhong;GUAN Hua;BU Xinyi;WANG Tingting;LIU Shuyang;LU Weiping;CHENG Hao;LI Lujun;BAO Hongguang(Department of Anesthesiology,Nanjing First Hospital,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院麻醉疼痛科,210006 [2]南京市中西医结合医院麻醉科

出　　处：《临床麻醉学杂志》2018年第12期1180-1183,共4页Journal of Clinical Anesthesiology

基　　金：江苏省科技基金项目(BL2014012);南京市科技发展计划项目(YKK14085)

摘　　要：目的研究超声引导下射频消融治疗痛性神经瘤的临床疗效。方法选择顽固性痛性神经瘤患者20例,男12例,女8例,年龄23～75岁,BMI 18.1～27.9kg/m^2,ASAⅠ或Ⅱ级,随机分为两组:治疗组(A组,n=10)和对照组(C组,n=10)。A组在超声引导下行射频消融治疗痛性神经瘤;C组在超声引导下行痛性神经瘤亚甲蓝局部注射治疗。记录患者治疗前后神经瘤体直径大小、残肢末端外围周长;记录治疗后3d、治疗后2周、治疗后3个月随访时VAS疼痛评分与发作频次;采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估患者治疗前、治疗后的抑郁、焦虑状况;记录治疗前后镇痛药物的使用情况。结果与C组比较,A组患者治疗后神经瘤体直径较治疗前明显缩小,残肢末端外围周长较治疗前明显减少;与治疗前比较,A组治疗后VAS评分明显下降,HAMA与HAMD评分明显降低(P<0.01);无一例严重并发症发生。结论超声引导下射频消融治疗痛性神经瘤疗效确切,创伤小,能改善患者的焦虑、抑郁症状,可以安全有效地应用于临床。Objective To study the clinical efficacy of ultrasound-guided radiofrequency ablation for painful neuroma.Methods Twenty patients with painful neuroma,12 males and 8 females,aged 23-75 years,BMI 18.1-27.9kg/m^2,falling into ASA physical statusⅠ orⅡ,were randomly divided into two groups:group A(n = 10)and group C(n = 10).Group A was performed radiofrequency ablation for the treatment of painful neuroma guided by the ultrasound system.Group B was performed local injection of methylene blue for painful neuroma guided by the ultrasound system.Comparison of changes in the diameter of neuroma and the peripheral circumference of the residual limb before and after the treatment.Visual analog scores(VAS)and frequency of pain occurrence were used to record pain scores 3 days,2 weeks and 3 months after surgery,and the frequency of oattacks(frequency/day).Patients were assessed for depression and anxiety using the Hamilton Anxiety Scale(HAMA)and the Hamilton Depression Rating Scale(HAMD)before and after surgery.The use of analgesic drugs was recorded before and after treatment.Results Compared with group C,the diameter of neuroma in group A was significantly smaller than that before surgery.Peripheral circumference of the residual limb was reduced compared with preoperative one.The VAS score and frequency of pain occurrence were significantly decreased in group A,HAMA and HAMD scores were significantly lower than those before treatment(P < 0.01).No other serious complications occurred.Conclusion Ultrasound-guided radiofrequency ablation for the treatment of painful neuroma,effective and less invasive,can improve the anxiety and depressive symptoms of patients,and is a safe and effective clinical application.

关 键 词：痛性神经瘤 超声引导 射频消融 焦虑 抑郁 

分 类 号：R614[医药卫生—麻醉学] R739.4[医药卫生—外科学]