CT引导下神经根射频联合交感神经射频毁损治疗带状疱疹后遗神经痛的疗效观察

CT-guided Combined RF Thermocoagulation of Dorsal Root Ganglion and Sympathetic Nerve in Treatment of Postherpetic Neuralgia

目的观察CT引导下神经根射频联合交感神经射频毁损治疗带状疱疹后遗神经痛(PHN)的疗效和相关并发症情况,以期提高其临床疗效。方法选择2005—2009年首都医科大学宣武医院疼痛科门诊收治的PHN患者40例,按照随机数字表法将患者分为对照组和治疗组,每组20例。对照组采用神经根85℃连续热凝射频进行治疗;治疗组采用神经根射频联合交感神经射频毁损85℃连续热凝射频治疗。观察患者治疗后1周、1个月、6个月、2年时的疼痛视觉模拟评分(VAS评分)、生存质量评分(QOL评分)、麻木评分及并发症情况。结果治疗后两组患者VAS评分逐渐降低,两组治疗后1个月和6个月时比较,差异均有统计学意义(P<0.05);QOL评分逐渐升高,但两组治疗后1周、1个月、6个月、2年时比较,差异均无统计学意义(P>0.05);麻木评分逐渐降低,两组治疗后6个月和2年时比较,差异有统计学意义(P<0.05)。对照组治疗后无相关并发症出现,治疗组出现霍纳氏综合征1例、代偿性多汗1例。结论 CT引导下神经根射频联合交感神经射频毁损治疗PHN中远期疗效较好,可有效改善患者的麻木现象,但较易出现霍纳氏综合征等相关并发症,部分患者疼痛控制不是很理想,有待于进一步明确其作用机制并提高操作者技术水平。

Objective To evaluate the efficacy of CT - guided radiofrequency （RF） thermocoagulation of dorsal root ganglion and sympathetic nerve on postherpetic neuralgia （PHN）. Methods Forty PHN outpatients admitted to Xuanwu Hospi- tal from 2005 to 2009 were divided randomly into control group and treatment group, 20 in each. Control group were treated with dorsal root ganglion 85 ℃ consecutive RF thermocoagulation, treatment group with combined 85 ℃ consecutive RF thermocoagu- lation of dorsal root ganglion and sympathetic nerve. Visual analogue scale （VAS）, quality of life （QOL） scores, numbness score and complications were compared 1 week, 1 month, 6 months, 2 years after treatment. Results VAS scores decreased gradually in 2 groups, significantly different between 2 groups 1 week or 6 months after treatment （ P 〈 0. 05 ） ; QOL increased gradually, but there was not difference 1 week, 1 month, 6 months, 2 years after treatment （P 〉 0. 05）. Numbness scores de- creased, there was difference 6 months, 2 years after treatment （ P 〈 O. 05 ）. After treatment no related complications were noted in control group, but in treatment group 1 case of Homer＇s syndrome and 1 compensatory hyperhidrosis, not influencing curative effects. Conclusion CT - guided combined RF thermocoagulation of dorsal root ganglion and sympathetic nerve, having good middle- and long -curative effects on PHN, can improve numbness effectively but may easily cause related complications such as Homer＇s syndrome and unsatisfactory pain control in some patients, the mechanism of which needs to be further confirmed.