超声引导腹腔神经丛阻滞对上腹部恶性肿瘤的止痛效果

Analgesic effect of neurolytic celiac plexus block guided by ultrasonography in advanced maligancies

目的 探讨超声引导注射无水乙醇阻滞腹腔神经丛对上腹部恶性肿瘤的止痛效果。方法 在识别腹腔神经丛及肠系膜上丛声像图特征的基础上 ,在超声引导下经腹穿刺 ,穿刺角度与腹腔动脉、肠系膜上动脉根部呈 2 0～ 30°夹角 ,向腹腔动脉、肠系膜上动脉、腹主动脉、下腔静脉等两旁及肿瘤压迫部背侧区域行多点无水乙醇注射 ,注射量 2 0～ 5 0ml。穿刺时经过肿瘤者 ,退针时向肿瘤内注射无水乙醇。结果 2 8例上腹部晚期恶性肿瘤患者接受治疗 ,其中 15例 (5 3.6 % )止痛效果为一时性完全缓解 ,12例 (4 2 .8% )部分缓解 ,总有效率为 96 .4% (2 7/ 2 8)。止痛效果与乙醇注射量有一定关系 ,注射量≤ 12ml者 4例 ,1例无效 ,3例部分缓解 ;注射 15～ 2 8ml者 6例 ,2例获一时性完全缓解 ;注射30～ 5 0ml者 18例 ,13例 (72 .2 % )达一时性完全缓解 ,2例经 2次注射、1例经 3次注射后达死亡前完全止痛 (3～ 6个月 )。对 9例经过肿瘤穿刺者同时向肿瘤内注射乙醇 ,6例肿瘤缩小 ,局部压痛明显缓解。 9例 (32 .1% )发生并发症 ,其中 4例为体位性低血压 ,2例呕吐 ,2例呃逆 ,1例腹泻 ,经对症处理均缓解。结论 超声引导腹腔神经丛阻滞对上腹部晚期肿瘤所致顽固性疼痛 ,为较安全有效可行的止痛方法之一。

Objective To investigate the analgesic effect of celiac plexus block with anhydrous alcohol in patients suffering form advanced abdominal malignancies. Methods Ultrasonographically demonstrated and guided, 20 to 50 ml of anhydrous alcohol is injected into the celiac plexus and superior mesenteric plexus by fine needle of 22G. The injecting angle between the needle and the aorta is 20 to 30 degree. The injecting fieldis mainly located around the celiac plexus and the dorsal part of tumor are also injected. Sometimes if the tumor is rather large, an appropriate amount of alcohol was injected inside too. Results Twenty eight cases of advanced abdominal malignancies were treated, among whom 96.4% achieved analgesic effect of different degree, 53.6%(15 cases) achieved the period of pain relief over three days, and 42 8%(12 cases) achieved partial relief. The analgesic effect is correlated with the amount of alcohol injected, i.e. no complete relief was observed in the four patients who received less than 12 ml, while two out of six could get transient complete relief in those who received 15 to 28 ml. In the group of 30 to 50 ml, 72.2% (13 cases) could get complete pain relief. Nine cases with big tumor received injection in side the tumor, with six tumors resvlting in shrinkage or necrosis, significant pain relief also achieved in these cases. Complications occurred in nine cases (32.1%), with four cases of postural hypotension, two cases of vomiting, two cases of hiccup and one case of diarrhea. Conclusion Neurolytic celiac plexus block guided by ultrasonography is a safe and effective modality in the management of intractable pain resulted from advanced abdominal malignancies.