脑下垂体阻滞术的临床应用

CLNICAL APPLICATION OF NEUROADENOLYSIS OF PITUITARY GLAND

应用脑下垂体阻滞术于一例全身性顽痛及四例癌痛的治疗，获得满意效果。经Ｘ线检查了解蝶窦、蝶鞍、筛窦所见，并用鼻镜确认鼻腔有无异常，据此选定拟穿刺的鼻孔。平卧全麻后在Ｘ线电视荧光屏下，用特制的脑下垂体双重套针行经鼻脑下垂体穿刺，针尖穿过鞍底到鞍内脑下垂体后，注入造影剂并拍片确认针位正确，注入无水乙醇１．８～２．０ｍｌ。分别用于全身性顽痛、宫颈癌Ⅲ期ｂ、转移性肺癌、外阴癌、卵巢癌痛。本组５例平均疼痛记分（ＰａｉｎＳｃｏｒｅ）从１０降至２．６，疼痛消失或减轻。提示该法首选于激素依赖性癌痛，也可用于非激素依赖性癌痛及全身顽痛的治疗。

Five patients,one with whole body obstinate pain and four with cancer pain were treated by neuroadenolysis of the pituitary gland(NALP).The effects were satisfactory.X-ray examination was performed before NALP to find out the conditions of the sphenoid sinus,sphenoid saddle and ethmoid sinus.Nasal cavities were checked with the nasal mirror.According to the results of preliminary examinations the right or left nasal cavity was selected as route of penetration.The patient lay down on the X-ray table at supine position.After general anesthesia under X-ray fluroscopy the double needle of NALP was inserted into the sphenoidal sinus.Radiographol was injected to assure the correct position of the needle placement,and 1.8～2.0ml of dehydrated alcohol was injected into the pituitary.The method was used to patients with whole body obstainate pain,and uterocervical cancer Ⅲ/b,metastasic lung cancer,vulvar vaginal cancer and ovarian cancer,respectively,The degree of pain relief was assessed by the pain score.the mean pain score changed from 10 down to 2.6 after the treatment.The authors suggested that hormone related cancer is the first choice for NALP,followed by non-hormonrelated cancer pain and whole body obstinate pain.