脑立体定向损毁中央中核、杏仁核治疗癌性顽痛

Brain Stereotaxic Therapy for Chronic Cancerous Pain by Spoiling Thalamic Nuclei

【目的】应用脑立体定向技术 ,对顽固癌痛进行有效治疗 ,并探讨癌性顽痛的发生机制。【方法】使用安柯ASA 6 0 2型定向仪 ,对 46例癌痛患者分别采用CT直接定位 ,MR成像定位及脑室造影确定大脑原点等不同方法 ,对颅内阴性靶点进行三维成像 ,确定靶点位置并用射频对其进行损毁 ,并与 38例长期口服吗啡类止痛药物的同类患者进行对照。【结果】 46例不同晚期癌痛病人中 ,手术组术后疼痛控制 43例 ,疼痛缓解 3例 ;药物组疼痛控制 3例 ,缓解 35例 (χ2 =5 4 16 ,P <0 0 1)。【结论】立体定向丘脑中央中核、杏仁核损毁术操作简单、创伤小、易于推断靶点位置 ,对癌性顽痛止痛效果明显优于传统药物治疗。

Objective To treat chronic cancerous pain by spoiling the thalamic nuclei with brain stereotaxic system and discuss the pathogenesis of chronic cancerous pain. Methods Locating the negative target with brain stereotaxic system (guided by CT, MR or ventriculography), the target was spoiled by radioheating. The effects were compared with that of morphine in 38 cases.Results Among 46 patients treated by the system,43 got pain controlled, 3 got remission. As for 38 cases treated by morphine, only 3 got pain controlled and 35 got remission(χ 2 test, P<0.01).[Conclusion] Spoiling thalamic nuclei by stereotaxic is a much more effective way for treating chronic cancerous pain than morphine. It is easy to operate and has little damage to the brain.