腰交感神经阻滞术在癌性腰腿痛治疗中的应用

THE APPLICATION OF LUMBAR SYMPATHETIC NERVE BLOCK FOR THE TREATMENT OF CANCER LUMBAR AND LEGS PAIN

晚期癌患者4例（男3，女1）因腰2、腰3椎体及骼骨转移伴严重腰腿痛，在CT引导下行腰交感神经酒精阻滞治疗，获得了满意的治疗效果。患者疼痛评分（VAS）从治疗前的9～10（平均9．75）降至治疗后的1～3（平均2），而且完全撤掉了治疗前所必需的较大剂量的麻醉性止痛药。2例同时伴有下肢Ⅲ～Ⅳ废水肿的患者，经治疗后降至0～1度。神经阻滞穿刺过程中及之后均未出现严重并发症。

Four patients (male 3, female 1), with advanced carcinoma of prostate , lung,rectum and breast respectively , suffered from intractable severe lumbar and/or legs pain.Two of the 4 patients had' Ⅲ -Ⅳ lower extremity edema. They were treated by CT-guidedlumbar sympathetic nerve block (ISNB) with alcohol at the level of L2 and L3. CT-monitorwas used to measure the distance of point of insertion from the midline, the angulation inrelation from horizon and the depth from the point of insertion to the lumbar sympatheticganglion. A 22-G 150mm long biopsy needle was inserted with assistance of a guide apparatus. During the process of puncture, CT image was obtained every 30 mm puncture depth totest the site of needle tip. 6 ml of contrast solution (2% lidocaine 4ml and ultravist 2 ml)was injected through the needles at L2 and L3 respectively . Ten minutes later, a mixed solution (99-5 % alcohol 7ml, 2 % lidocaine 2ml, ultravist 1ml) was injected respectively intothe same Place as above. When bilateral LSNBs was necessery, the interval between twopunctures was at least 2 days. After LSNB, the mean pain score (VAS) decreased from9. 75 to 2, the degree of 2 patients' edema was lowered from Ⅲ -Ⅳ o to 0- Ⅰ '. There wasno complication that must be treated after LSNB. The results indicated that CT-guided LSNBis a safe and powerful method for the treatment of cancer lumbar and legs pain.