CT引导弯针穿刺在腹腔神经丛阻滞术中的临床应用

Clinical application of CT-guided curve-needle percutaneous ethanol injection for celiac plexus block analgesia

目的评价CT引导下弯针穿刺技术在腹腔神经丛阻滞止痛中的应用价值。方法32例晚期癌症患者,其中13例伴有后腹膜淋巴结广泛肿大并融合成团。所有病例均为顽固性上腹部疼痛,采用麻醉类止痛药治疗及放射治疗,止痛效果均不佳。应用CT引导下弯针穿刺腹腔神经丛阻滞方法进行治疗。结果治疗后即刻、2周、4周、8周、12周、16周的止痛有效率分别为100%、100%、96.9%、90.6%、87.5%、84.4%。肿大淋巴结均有明显坏死缩小。结论联合应用双侧膈脚前、后阻滞及穿入淋巴结内阻滞疗法可取得较好的止痛效果,弯针穿刺技术使阻滞止痛更加简便。

Objective：To validate the clinical value of CT-guided curve-needle percutaneous ethanol injection （CNPEI） for celiac plexus block analgesia. Methods： Thirty-two patients with end-stage cancer, including 13 complicated with extensive retroperitoneal lymph node enlargement and fusion, were enrolled in this study. All patients complained of refractory upper abdominal pain and had received narcotic analgesics and radiotherapy, but the analgesic effect was not good. CT-guided CNPEI was therefore prescribed. Results： The effective rates of CT-guided CNPEI were 100;, 100;, 96.9;, 90.6%, 87.5%, and 84.4% immediately,and at 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after treatment, respectively. All enlarged lymph nodes had obvious necrosis and became shrunk. Conclusion： Combined application of bilateral anterior and posterior diaphragmatic crura block and trans-lymph node block can produce good analgesic effects, and curve-needle puncture make the above technique simpler.