不同剂量无水乙醇腹腔神经丛阻滞治疗上腹癌痛的疗效观察  

Clinical observation on upper abdominal pain caused by cancer after neurolytic celiac plexus block with different doses of alcohol

作　　者：孙成建[1] 王彦华[1] 王松[1] 李子祥[1] 周岩冰[2] 赵清喜[3] 王承恩[1] 解玲玲[1] 刘彤晖[1] 任伟超[1] 

机构地区：[1]青岛大学附属医院介入科,山东青岛266003 [2]青岛大学附属医院普外科,山东青岛266003 [3]青岛大学附属医院消化内科,山东青岛266003

出　　处：《中国医学影像技术》2014年第10期1536-1540,共5页Chinese Journal of Medical Imaging Technology

基　　金：青岛市科技计划项目(08-2-1-3-nsh)

摘　　要：目的观察不同剂量无水乙醇腹腔神经丛阻滞术治疗晚期上腹部癌痛患者的疗效。方法选取45例保守治疗无效的晚期上腹部癌痛患者，并随机分为15ml无水乙醇组（A组）、20ml无水乙醇组（B组）和25ml无水乙醇组（C组），每组15例，在CT引导下经前腹壁或背侧入路行经皮腹腔神经丛阻滞术，止痛效果分为0～Ⅲ级，分别于术后1个月、3个月时评价止痛效果。结果随访观察3个月，1个月、3个月时20ml和25ml无水乙醇组有效率显著均高于15m1无水乙醇组（P均〈0.01）；而20m1无水乙醇组与25ml无水乙醇组有效率差异无统计学意义（P〉0.05），但25ml无水乙醇组术后疼痛的患者数明显高于20ml组。20ml无水乙醇组术后1个月的有效率为93.33％（14／15），3个月有效率为73.33％（11／15），均未发生严重并发症。3组患者术后1个月与术后3个月疗效差异无统计学意义（P均〉0.05）。结论用20ml无水乙醇腹腔神经丛阻滞治疗晚期上腹部癌痛是一种安全、有效的方法。Objective To evaluate the therapeutic effect of neurolytic celiac plexus block （NCPB） with different doses of alcohol in treatment of abdominal pain caused by terminal visceral cancer. Methods Forty-five patients with intractable upper abdominal pain resulted from malignancies and failed with conservative measures were randomly divided into three groups based on the dose of dehydrated alcohol： A （15 ml）, B （20 ml） and C （25 ml）, 15 patients each group. All the patients received NCPB through anterior or posterior-lateral approach guided by CT. Antalgic effect were classified to 0—Ⅲ grades and were evaluted in 1 month （short-term） and 3 months （long-term）after operation. Results During the 3 months following-up, the effective rates of 15 ml dehydrated alcohol group in 1 month and 3 months after operation were higher than that of 20 ml and 25 ml dehydrated alcohol groups （all P〈0.01）, but there were no significant differences between 20 ml and 25 ml dehydrated alcohol groups. The number of patients who suffered abdominal pain after NCPB in 25 ml dehydrated alcohol group were higher than that in 20 ml dehydrated alcohol group. The effective rate of 20 ml dehydrated alcohol group in 1 month and 3 months after operation were 93.33% （14/15） and 73.33%（11/15） respectively. No severe complications occurred. There were also no significant differences between long-term efficacy and short-term efficacy in the same therapeutic group. Conclusion NCPB with 20 ml dehydrated alcohol is an effective and safe modality in treatment of intractable pain resulting from advanced abdominal malignancies.

关 键 词：疼痛 腹部肿瘤 腹腔神经丛阻滞术 

分 类 号：R735[医药卫生—肿瘤] R730.5[医药卫生—临床医学]