脊髓背根入髓区切开治疗癌性神经病理性疼痛的远期疗效

LONG-TERM EFFICACY OF DORSAL ROOT ENTRY ZONOTOMY FOR TUMORASSOCIATED NEUROPATHIC PAIN

目的:探讨脊髓背根入髓区(dorsal root entry zone,DREZ)切开术治疗癌性神经病理性疼痛的远期疗效及安全性。方法:收集癌性神经病理性疼痛病人4例,其中3例为直肠癌侵犯骶神经致会阴区神经病理性疼痛,1例为左侧乳腺癌侵犯臂丛神经导致上肢神经病理性疼痛。4例均接受患侧损伤和疼痛节段脊髓背根入髓区切开术治疗,显微镜下用双极电凝切开病变节段脊髓背根的入髓区。随访2年以上,分别于术后2周、术后每半年采用视觉模拟评分(visual analogue scale,VAS)评估手术疗效。结果:术后2周,2例疼痛消失,2例疼痛缓解>75%。随访2年,疗效满意率逐渐下降,2例疼痛缓解>75%,1例疼痛缓解60%,1例术后6月死亡。并发症发生情况:同侧下肢深感觉障碍3例,痛觉过敏2例,在术后6月随访时均有不同程度恢复。结论:脊髓背根入髓区切开术是一种治疗癌性神经病理性疼痛的安全、有效的措施。

Objective： To analyze the long-term efficacy and safety of dorsal root entry zonotomy （DREZotomy） in patients with tumor-associated neuropathic pain. Methods： Four patients with tumor-associated neuropathic pain （3 with eolorectal cancer, 1 with breast cancer） were treated by DREZotomy. Microsurgical lesion was made with bipolar forceps along the DREZ. The patients were assessed by visual analogue scale （VAS） at 2 weeks, 6 months, 12 months, 18 months and 24 months after the surgery. Results： The greatest pain relief was reported at 2 weeks after the DREZ procedure. Two patients had 100% pain relief and two patients had more than 75% pain relief. Over 2-year follow-up, the rate of satisfaction was slightly decreased. Two patients had more than 75% pain relief and one patient had 60% pain relief, with one patient died at the 6 months after surgery because of colorectal cancer. The major complications included dysfunction of deep sensory over the ipsilateral lower extremity （n = 3） and hyperalgesia （n = 2）. These complications were usually improved within 6 months after surgery. Conclusion： Microsurgical lesions in the dorsal root entry zone could be used for pain relief in patients with tumor-associated neurooathic oain. It is an effective and safe measure.