丘脑中央中核毁损治疗癌症顽固性疼痛的实验及临床应用  

Damaging Nucleus Centromedianus Thalami for Treatment of Cancer Pain in Experimental and Clinical Aspects

作　　者：刘灵慧[1] 陈善成[1] 龙大宏[2] 唐斌[3] 项永生[1] 杜天明[1] 

机构地区：[1]广州暨南大学医学院第一附属医院神经外科,广东广州510630 [2]广州医学院解剖教研组,广东广州510180 [3]广州医学院生理教研组,广东广州510180

出　　处：《癌症》2003年第3期314-316,共3页Chinese Journal of Cancer

摘　　要：背景与目的:目前对癌症顽固性疼痛(简称顽痛)尚未有较好的治疗方法。有报道丘脑中央中核(centromedianusnucleus,CM核)在中枢镇痛中起着重要作用,本研究旨在通过大鼠动物实验和临床治疗90例多种癌症顽痛患者,探讨毁损CM核后的镇痛效果。方法:选用远交群大鼠(SpragueDawley大鼠,SD大鼠)10只,电解毁损其CM核,采用电刺激鼠尾———嘶叫法进行测痛,同时设假毁损组SD大鼠10只,除不通电毁损外,其余手术条件均与毁损组相同。以电流强度(mA)的变化,测定大鼠痛阈的改变。临床治疗癌症顽痛患者90例,其中肺癌36例、鼻咽癌21例、结肠癌10例、胰腺癌8例、骨癌8例、肾癌4例、肝癌3例。应用脑立体定向技术,对CM核行热凝射频毁损。采用世界卫生组织推荐的10分法评定手术前后的疼痛程度。结果:毁损组大鼠痛阈术前为(0.152±0.034)mA,术后为(0.326±0.05)mA,两者差异有显著性(P<0.001);假毁损组大鼠痛阈术前为(0.142±0.027)mA,术后为(0.138±0.035)mA,两者差异无显著性(P>0.05)。本组患者术前疼痛计分均在7分以上,术后降至0～3分。随访发现,24例患者有不同程度疼痛复发,但计分在5分以下;其余患者均持续止痛,有3例达2年多。术后并发症,嗜睡15例,尿失禁10例,语言错乱8例,一侧动眼神经不全麻痹3例,经对症处理后上述症状均消?BACKGROUND &OBJECTIVE: There is no perfect method to control cancer pain. It is reported that nucleus centromedianus thalami plays a crucial role in the analgesia of central nerve system. The authors conducted this study, based on rat experiments, together with the clinical treatment of more than 90 cases involving various cancer pains, to explore the pain relieving effects after damaging nucleus centromedianus thalami. METHODS: Ten SD rats, whose nucleus centromedianus thalami were damaged by electrolysis, were chosen, and then measured the pain degree by applying electricity to stimulate the tails of the rats. Meanwhile, another 10 rats, whose nucleus centromedianus thalami were not damaged, were chosen as the control group, among whom the same operation procedure as the above mentioned was carried out. The range of pain scale of the rats was measured by the alteration of the electric intensity. A total of 90 cases of intractable cancer pain were treated, including 36 cases of lung cancer, 21 cases of nasopharyngeal carcinoma, 10 cases of intestinal cancer, 8 cases of cancer of pancreas, 8 cases of osteocarcinoma, 4 cases of carcinoma of kidney, 3 cases of hepatocarcinoma. The brain stereotactic technique was used to damage the nucleus centromedianus thalami with radiofrequency coagulation lesions. The 10 grade method recommended by WHO was used to rank pain degree. RESULTS: Pain scale of rats in the first group rose from 0.152±0.034 mA prior to the damage to 0.326±0.05 afterwards, with a significant difference (P< 0.001), while the pain scale of the control group dropped from 0.142±0.027 mA prior to the operation to 0.138±0.035 mA afterwards, with no remarkable difference (P > 0.05). To patients with cancer pain, the average pain grade in this study went above 7 scores, but dropped to 0 3 scores after operation, according to the 10 grade method by WHO. A life long tracing observation indicted that cancer pain in 24 cases relapsed to varying degrees but below 5 scores, the rest of the patients were anal

关 键 词：癌性疼痛 丘脑中央中核 热凝射频毁损 止痛 大鼠 

分 类 号：R730.5[医药卫生—肿瘤]