奇神经节持续射频与高电压长时程脉冲射频治疗直肠癌会阴痛临床研究  

Continuous radiofrequency versus high-voltage,long-duration pulsed radiofrequency of ganglia impar for the treatment of perineal pain in patients with rectal cancer:a clinical study

作　　者：钟波[1] 张桃梅 王志强 陶平 王怀明[2] 张爱民 ZHONG Bo;ZHANG Taomei;WANG Zhiqiang;TAO Ping;WANG Huaiming;ZHANG Aimin(Department of Anesthesiology,Yanjiang District People′s Hospital,Ziyang,Sichuan Province 641399,China)

机构地区：[1]资阳市雁江区人民医院麻醉科,四川资阳641399 [2]四川省肿瘤医院(研究所)/四川省癌症防治中心/电子科技大学附属肿瘤医院麻醉科

出　　处：《介入放射学杂志》2025年第2期154-159,共6页Journal of Interventional Radiology

基　　金：四川省自然科学基金(2022NSFSC1346);四川省医学会科研项目(S21052);资阳市医学科学课题项目(KY2023035)。

摘　　要：目的评价DSA引导下奇神经节持续射频(CRF)与高电压长时程脉冲射频(HL-PRF)治疗直肠癌会阴痛的近期有效性和安全性。方法采用单中心、随机、主动对照、双盲试验法,根据射频治疗模式将57例直肠癌伴会阴痛患者以1∶1比例随机分为CRF组(n=28)和HL-PRF组(n=29)。主要结局指标为术前(T0),术后24 h(T1)、1周(T2)、1个月(T3)、3个月(T4)、6个月(T5)时点会阴部疼痛数字评价量表(NRS)评分;次要结局指标为T0、T1、T2、T3、T4、T5时点坐姿时间、9项患者健康问卷(PHQ-9)评分、Pittsburgh睡眠质量指数(PSQI)评分、术后口服吗啡剂量及会阴部麻木发生率。结果与T0时点相比,两组患者T1~T5时点NRS评分、PHQ-9评分及PSQI评分显著下降,坐姿时间显著增加(均P<0.05),术后口服吗啡剂量和会阴部麻木发生率差异无统计学意义(均P>0.05)。与CRF组相比,HL-PRF组T1~T3时点NRS评分、PHQ-9评分、PSQI评分、坐姿时间及术后口服镇痛药物等差异无统计学意义(均P>0.05);T4~T5时点NRS评分、PHQ-9评分、PSQI评分显著增加(均P<0.05),坐姿时间显著降低(P<0.05)。结论奇神经节CRF和HL-PRF均能改善晚期直肠癌患者癌痛伴会阴痛,并提高其生活质量。但CRF长期疗效优于HL-PRF。Objective To evaluate the efficacy and safety of DSA-guided continuous radiofrequency ablation(CRF) and high-voltage, long-duration pulsed radiofrequency(HL-PRF) of ganglia impar in treating perineal pain in patients with rectal cancer.Methods This study is a single-center, randomized, active-controlled, double-blind trial that included 57 rectal cancer patients with perineal pain.At a 1∶1 ratio, the patients were randomly divided into CRF group(n=28) and HL-PRF group(n=29).The primary outcome indicators were the pain numerical rating scale(NRS) scores determined at the preoperative(T0),postoperative 24 h(T1),one week(T2),one month(T3),3 months(T4) and 6 months(T5) time-points.The secondary outcome indicators included the sitting time at T0,T1,T2,T3,T4 and T5 time-points, the 9-item patient health questionnaire(PHQ-9) score, the pittsburgh sleep quality index(PSQI) score, the postoperative oral morphine dosage, and the incidence of perineal numbness.Results Compared with the value at T0 time-point, in both groups the NRS score, PHQ-9 score and PSQI score at T1-T5 time-points were significantly decreased, while the sitting time become remarkably increased(all P<0.05).No statistically significant differences in postoperative oral morphine dosage and incidence of perineal numbness existed between the two groups(both P>0.05).There were no statistically significant differences in NRS score, PHQ-9 score and PSQI score, sitting time and oral morphine dosage at T1,T2,T3 time-points between CRF group and HL-PRF group(all P>0.05),while at T4 and T5 time-points the NRS score, PHQ-9 score and PSQI score in HL-PRF group were significantly higher than those in CRF group(all P<0.05),and the sitting time in HL-PRF group was strikingly lower than that in CRF group(P<0.05).Conclusion Both CRF and HL-PRF of ganglion impar can alleviate perineal pain in patients with advanced rectal cancer and improve the quality of life of patients.CRF is superior to HL-PRF in the long-term efficacy.

关 键 词：奇神经节 射频热凝 脉冲射频 会阴痛 癌痛 DSA引导 

分 类 号：R735.37[医药卫生—肿瘤]