腹腔神经丛阻滞术治疗上腹部顽固性癌性疼痛的临床应用研究

Study of the clinical application of neurolytic celiac plexus block to controlling intractable upper abdominal pain caused by cancer

目的评价腹腔神经丛阻滞术治疗上腹部顽固性癌性疼痛的止痛效果。方法105例晚期癌症患者,67例伴有后腹膜淋巴结广泛肿大并包绕神经、血管,均有顽固性上腹痛,经CT导引穿入膈脚前及后腹膜肿大淋巴结内行两侧腹腔神经丛乙醇阻滞术。结果经4个月随访观察,在2周,1,2,3,4个月,止痛总有效率分别为100.0%、98.1%、97.1%、93.8%和90.4%。止痛效果显著的患者,可观察到乙醇扩散较完全,能从两侧包绕腹主动脉,肿大的淋巴结有明显坏死。本组无一例严重并发症发生。结论CT导引下腹腔神经丛阻滞术治疗上腹部顽固性癌性疼痛是一种安全、有效的方法,值得推广应用。

Objective To evaluate the efficacy of neurolytie celiac plexus block （NCPB） in treatment of intractable upper abdominal pain caused by cancer. Methods 105 advanced cancer sufferers who had intractable upper abdominal pain. Sixty-seven accompanied with extensive retroperitoneal lymph nodes enlargement and involving celiac plexus. Neurolytie celiac plexus block with ethanol was performed with the needle tip positioned into the masses fusing with lymph nodes. Results During the 4 months follow-up, the total effective rates of pain relief in 2 weeks, 1 month, 2 months , 3 months and 4 months were 100.0%, 98.1%, 97.1%, 93.8 % and 90.4% respectively. Satisfactory pain relief was obtained when the neurolytie solution encircled the aorta adequately from two sides. The tumorous retroperitoneal lymph nodes shrank markedly with severe necrosis. There were no severe complications in any case. Conclusion NCPB guided by cr was proved to be an effective and safe means for controlling intractable upper abdominal cancer pain and should be popularized.