腹腔神经节(丛)酒精阻滞治疗癌性腹痛的临床和实验动物组织学的初步观察

PRIMARY OBSERVATION OF HISTOLOGY IN CLINIC AND EXPERIMENTAL ANIMALS TO TREAT CANCEROUS ABDOMINAL PAIN BY ALCOHOL ON CELIAC GANGLIA (PLEXUS)

目的：腹腔神经节（丛）酒精破坏性阻滞是上腹部内脏癌性疼痛止痛常用的方法，本文为了探讨腹腔神经节（丛）阻滞时，酒精浓度、阻滞后时间与止痛效果之间的关系；方法：４３例中晚期上腹部癌性疼痛病人随机用５０％酒精（１４例），７５％酒精（１８例）及１００％酒精（１１例）２０ｍｌ分别注射到病人腹腔神经节（丛）周围，另将活兔腹腔神经节（丛）浸于５０％、７５％、１００％及０．９％生理盐水溶液里１ｄ、３ｄ、一周的组织学变化作为对照研究；结果：ｄ１疼痛完全消失或明显缓解１１例（２５．６％）。ｄ３３４例（７９．１％），一周内３９例（９０．６％）。对照实验显示：浸泡在不同浓度的酒精浓度中一周后均表现为神经元的核仁消失，尼氏小体变细小，髓鞘消失等组织学变化，而浸于生理盐水溶中则表现为神经元胞质模糊，神经纤维结构自溶现象；结论：酒精可使腹腔神经节（丛）神经元及其周围神经纤维变性、脱鞘、丧失正常的传导功能。从实验结果来看，用药后１ｄ内起效，一周内几乎便部达到止痛目的。长期止痛效果与酒精浓度关系不大，然而临床效果观察与实验结果有差异，应考虑其他一些原因。

Objective:Alcohol neurolytic blocks of celiac ganglia (plexus) commonly used procedures to control pain due to primary or metastatic cancer of the upper abdominal viscera.To investigate possible relationship between the effect of the pain relief and the concentration,duration of alcohol neurolysis of celiac ganglia (plexus).Methods:20ml of 50% alcohol (14 cases), 75% alcohol (18 cases) and 100% alcohol (11 cases) were randomly injected respectively to around celiac ganglia (plexus) of 43 patients of cancerous upper abdominal pain in middle and later stage.Celiac ganglia (plexus) of vital rabbit were submerged in 50%,75% and 100% alcohol solution and 0.9% saline for 1 day,3 days and 1 week.Results:the pain were completely disappeared or reduced obviously in 11 cases (25.6%) within 1 day,in 34 cases (79.1%) within 3 days and 39 cases (90.6%) within 1 week after injection.All showed that histologically the nucleolus of neuron were disappeared,Nissl body became thin and small myeline sheath were disppeared after submerging in alcohol solution,cytoplasm of neuron was not clear and nerves fibers autoplyzed in 0.9% normal saline in a week.Conclusion:We found that alcohol may induce neuron and their periphyral nerve fibers of celiac ganglia to degenerate,demyelinate and lost normal conduction.The fact was on effect on it in 1 day and analgesia in 1 week after injection,but there was no relationship between analgesic effect in a long period and concentration of alcohol.However,difference between experimental and clinical aspects,consideration of the other causes to reduce pain should be done.