神经松解加神经外膜内置管给药治疗灼性神经痛

Neurolysis combined with indwelling epineurial catheter drug delivery for treatment of causalgia: A report of 12 cases

目的 用神经手术及神经外膜内置管定期注入镇痛药物 ,以提高灼性神经痛的治疗效果。方法 对 12例周围神经损伤后发生灼性神经痛者 ,行神经束间松解术 ,并将硬膜外麻醉导管置于切开的神经外膜内 ,管口位于病变神经近端正常神经束间 ,管尾引出皮外 ,与皮肤固定后连接注射器。术后每隔4～ 6小时 ,从导管内推入布比卡因 ( 0 .5g L) 2～ 3ml。共 1周。结果 11例术后随访 6个月～ 2年 ,未见复发。 1例失访。结论 本法治疗灼性神经痛是有效的 。

Objective To improve the treatment outcome of causalgia by means of indwelling epineurial catheter delivery of analgesics after neurolysis. Methods 12 cases of causalgia after peripheral nerve injury were involved in this study. After interfascicular neurolysis, one end of the epidural catheter was placed under the incised epineurium with its open foramen facing the nerve fascicles proximal to the lesion segment. The other end was fastened to the skin and connected with a syringe. Postoperatively, 2～3 ml (0.5 g/L) bupivacaine was delivered through the catheter every four to six hours. Results Of the 11 cases which were followed for 6 months to 2 years, none had recurrence of the symptoms. One case lost follow up. Conclusions This method is effective for treatment of causalgia. The indication and long term result are subject to further investigation.