不同浓度乙醇腹腔神经丛阻滞治疗上腹部癌痛的临床观察

Clinical observation on upper abdominal pain caused by cancer after neurolytic celiac plexus block with different-concentration alcohol.

目的观察不同浓度乙醇腹腔神经丛阻滞术时晚期上腹部癌性疼痛患者的治疗效果。方法96例晚期上腹部癌痛患者随机分为50％乙醇组、75％乙醇组和无水乙醇组，每组32例，X线引导下分别于背侧入路实施经皮疆腔神经丛阻滞术，止痛效果被分为0～Ⅲ级，分别于术后2周、1个月、2个月及3个月时采用视觉模拟评分法（VAS）观察止痛效果。结果随访观察3个月，治疗后2周，1个月、2个月及3个月时用75％乙醇组和无水乙醇组的显效率和总有效率显著高于50％乙醇组。而75％乙醇组与无水乙醇组比较，显效率和总有效率差异无统计学差异。结论经皮腹腔神经丛75％乙醇和无水乙醇（15ml）阻滞治疗晚期上腹部癌性疼痛是一种安全、有效的方法。

Objective To study the therapeutic effect for intractable upper abdominal pain caused by cancer after neurolytic celiac plexus block（NCPB） with different-concentration alcohol.Methods Ninty-six patients who had intractable upper abdominal pain resulted from malignancies were randomized into 50 % alcohol group, 75 % alcohol group, dehydrated alcohol group.All the patients received neurolytic celiac plexus blocks through posterior-lateral approach under X-Ray guidance.The results of pain relief classitied 0 - Ⅲ grade were evaluated by visual analog scale（VAS） in 2 weeks, l month,2 months and 3 months. Results During the 3 months followup, the excellence rate and total effective rates pain relief in 2 weeks, 1 month, 2 months and 3 months were distinctly lower in 50% alcohol group than those in 75% alcohol group and dehydrated alcohol group（ P 〈 0.01）, but there were no significant differences between 75 % alcohol group and dehydrated alcohol group in the effective rates and the total effective rates pain relief. Conclusion NCPB with 75 % or dehydrated （ 15ml）alcohol is an effective and safe modality in the management of intractable pain resulted from advanced abdominal malignancies.