纤维溶解疗法治疗放射性臂丛损伤16例初步报告

Fibrinolytic therapy in radiation-induced brachial plexopathy：16 cases report and review

目的 探讨纤维溶解疗法治疗放射性臂丛损伤的可行性与疗效,讨论其原理、适应证及注意事项.方法对临床诊断明确、排除肿瘤复发、转移的16例放射性臂丛损伤患者采用纤维溶解疗法进行治疗,具体方法为使用透明质酸酶、地塞米松、维生素B12、2%利多卡因进行臂丛阻滞和局部压痛点阻滞,每周1次,连续6～12次.结果 随访0.5～10.0年,手运动和感觉功能明显改善、疼痛明显减轻4例,占25.00%;感觉改善、疼痛缓解、运动功能无改善、病情不再进一步发展5例,占31.25%;感觉、运动及疼痛均无改善甚至逐渐加重7例,占43.75%.神经肌电图检查都有不同程度的改善.结论 纤维溶解疗法可以降解神经内外过剩的以透明质酸为代表的细胞间质,使其实现新的动态平衡,改善细胞间的物质交换,缓解神经内外的粘连与卡压,降低神经轴突的压力,为神经再生与功能恢复创造有利条件.

Objective To explore the feasibility and curative effect of extracellular matrix （ECM） fibrinolytic therapy in order to cure radiation-induced brachial plexopathy （RIBP） and to discuss the principle, indication and precautions. Methods The treatment was taken on 16 cases that had a definite clinical diagnosis and we took a systematic examination to make sure that there was no recurrence or metastasis of the tumor.Brachial plexus and tender area block was taken once a week by injection of mixture of hyaluronidase, hexadecadrol, Vitamine B12 and lidocaine. The therapy was applied for 6 to 12 weeks. Results All the patients were followed up for a period of 0.5 to 10 years. Four cases had an evident alleviation of the symptoms and got a function resumption of hands; 5 cases had an alleviation of pain and improvement of sensation and the progress of illness were terminated, but motor function didn＇t have improvement; 7 cases had a continued aggravation of the symptoms. All the cases found improvement in electromyography. Concluslon The aim of fibrinolytic therapy is to dissolve the extra ECM such as hyaluronic acid around nerves in order to achieve a new homeostasis. It can relieve the conglutination and entrapment at nerve inside and outside, reduce the pressure of neuraxon and create an availing condition for the regenesis of nerve and the regain of function.