CT引导下腹腔神经丛毁损治疗癌性上腹痛的效果  

Effects of CT-guided celiac plexus destruction on patients with poorly controlled cancerous upper abdominal pain

作　　者：谢广伦 郭大鹏 李志刚 刘畅 吴官鸿 XIE Guanglun;GUO Dapeng;LI Zhigang;LIU Chang;WU Guanhong(Department of Pain,the Affiliated Tumor Hospital,Zhengzhou University,Zhengzhou 450008)

机构地区：[1]郑州大学附属肿瘤医院疼痛科,郑州450008

出　　处：《郑州大学学报（医学版）》2020年第2期266-270,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省科技攻关计划项目(162102310320,172102310688)。

摘　　要：目的:回顾性分析CT引导下腹腔神经丛毁损治疗癌性上腹痛的效果。方法:因阿片类药物镇痛控制不佳住院治疗的癌性上腹痛患者167例,采用CT引导下腹腔神经丛毁损方案,对腹腔干或肠系膜上动脉被肿瘤包绕者直接穿刺、瘤体内注射无水乙醇与碘海醇混合液直至其在腹腔神经丛区域达到满意扩散,对有腹膜后转移导致癌性上腹痛者另取穿刺针穿刺、注射无水乙醇与碘海醇混合液,直至肿瘤或淋巴结被完全或至少大部分浸润。结果:与术前相比,术后患者疼痛明显缓解,术后第7天、1个月和3个月镇痛有效率分别为91.6%、83.2%和68.3%,优良率分别为69.5%、58.1%和38.9%。与术前相比,口服吗啡剂量减少,但随着镇痛效果的降低,口服吗啡剂量逐渐升高。术后患者恶心、呕吐发生率降低,术后第7天最低;术后一过性低血压发生率为37.7%,但经对症处理后迅速恢复;腹泻发生率为30.5%,一般症状较轻,经对症处理一般在术后7 d内恢复,但有2例患者发生迁延性腹泻,术后1个月仍需应用止泻药物。结论:CT引导下腹腔神经丛毁损用于阿片类药物镇痛效果不佳的癌性上腹痛患者,不但可提高镇痛效果,减少阿片药物的应用剂量,而且不良反应较少且轻微。Aim:To retrospectively analyze the effects of CT-guided celiac plexus destruction on patients with poorly controlled cancerous upper abdominal pain.Methods:A total of 167 patients with poorly controlled cancerous upper abdominal pain were treated with CT-guided celiac nerve plexus destruction.For those with celiac trunk or superior mesenteric artery surrounded by tumor,the tumor was punctured directly into and injected a mixture of ethanol and iohexol until it reached a satisfactory diffusion in the celiac nerve plexus area.For those with retroperitoneal metastasis,in addition to performing the above operations,another puncture needle was taken and a mixture of ethanol and iohexol was injected until the tumor or lymph nodes was completely or mostly infiltrated.Results:Compared with before surgery,the pain of the patients was significantly relieved.The analgesic effective rates were 91.6%,83.2%and 68.3%at 7 days,1 month and 3 months after surgery,and the excellent and good rates were 69.5%,58.1%and 38.9%at the same time.The oral morphine dose decreased compared with preoperation,but gradually increased with the decreasing analgesic efficacy.The incidence of nausea and vomiting decreased after surgery,and was the lowest at 7 days after surgery.The incidence of transient hypotension was 37.7%after surgery,and the patients recovered quickly after symptomatic treatment.The incidence of diarrhea was 30.5%,and the general symptom was mild and the patients generally recovered within 7 days after surgery.However,2 patients developed persistent diarrhea,and antidiarrheal drugs were still needed at 1 month after surgery.Conclusion:CT-guided celiac plexus destruction can be used in patients with poorly controlled cancerous upper abdominal pain,which can improve the analgesic effect,and reduce the application of opioids with fewer and milder side effects.

关 键 词：癌症 疼痛 腹腔神经丛 CT引导 

分 类 号：R730.6[医药卫生—肿瘤]