可控弯针经皮穿刺腹腔神经丛毁损术治疗上腹部癌痛18例

Percutaneous celiac plexus block using controllable curved needle for refractory carcinomatous upper abdominal pain:report of 18 cases

目的评价CT引导下22 G直针配以25 G可控弯针经皮穿刺腹腔神经丛毁损术(NCPB)治疗上腹部顽固性癌痛的疗效和安全性。方法回顾性分析了18例中、晚期恶性肿瘤患者,经三阶梯镇痛治疗无效仍有顽固性上腹部疼痛,在CT引导下25 G可控弯针经皮穿刺无水乙醇毁损腹腔神经丛。观察并随访术前,术后第2周,术后1、2、3、6个月对照WHO疼痛缓解程度标准对患者疼痛进行评估。结果本组18例患者行CT引导下穿刺成功率100%。近期疗效(<2周)的有效率为88.8%,完全缓解率为38.8%;远期疗效(>3个月)的有效率为50%,完全缓解率为20%。无一例术后严重并发症。结论 CT引导下经皮穿刺腹腔神经丛阻滞术是一种简便、安全、有效的治疗顽固性上腹部癌痛的方法。

Objective To evaluate the efficacy and safety of CT-guided percutaneous celiac plexus block （NCPB） using 25 G controllable curved needle together with 22 G straight needle in treating refractory carcinomatous upper abdominal pain. Methods A total of 18 patients with advanced refractory carcinomatous upper abdominal pain were enrolled in this study. The carcinomatous upper abdominal pain failed to the three-step analgesic therapy. Guided by CT scan, percutaneous injection of ethanol with a 25 G controllable curved needle to destroy celiac plexus was carried out in all patients. According to WHO pain relief standards, the relieving degree of pain was evaluated before NCPB and 2 weeks, one, 2, 3 and 6 months after NCPB. The results were analyzed. Results The technical success rate was 100%. The short-term （within 2 weeks） efficacy rate was 88.8%and the complete remission rate was 38.8%. The long-term （over 3 months） efficacy rate was 50% and the complete remission rate was 20%. No severe complications occurred. Conclusion For refractory carcinomatous upper abdominal pain, CT-guided percutaneous celiac plexus block is a simple, safe and effective treatment.