腰交感神经化学毁损性阻滞治疗相关疾病的并发症及预防措施

Complications of chemical lumbar sympathectomy and preventive measures

目的总结腰交感神经化学毁损性阻滞的常见并发症及预防措施。方法纳入嘉兴市第一医院疼痛医学科2011年9月至2016年9月在CT引导下行双侧腰交感神经无水乙醇化学毁损性阻滞治疗的患者，共258例，回顾性分析术中及术后并发症及相应的预防措施。结果258例患者516侧腰交感神经阻滞均按设定的穿刺入路穿刺到达设定的靶点，穿刺成功率为100%。其中16例患者单侧能抽吸出少量回血（3.1%，16/516），需调整针尖位置；29例单侧有部分无水乙醇沿穿刺针道漏入腰大肌间隙（5.6%，29/516），其中有7例出现单侧生殖股神经支配区麻木（1.4%，7/516），另有1例出现一侧下肢麻木和肌力下降，经向腰大肌间隙注入适量生理盐水稀释后，1个月内肌力恢复；有9例出现单侧无水乙醇沿椎体前外侧缘上行分布至L1椎体水平（1.7%，9/516），其中4例（1.6%，4/258）为男性患者，术后出现射精障碍。术毕退针后CT显示单侧腰大肌肿胀2例（0.4%，2/516），单侧竖脊肌肿胀3例（0.6%，3/516），无后腹膜血肿发生。结论CT引导下腰交感神经化学毁损性阻滞的常见严重并发症为注入乙醇后的神经系统受累（累及脊神经腰丛和男性L1交感神经节），局部麻醉药试验有助于预防和及时发现，实施生理盐水稀释法是有效的救治措施。

Objective To summarize the common complications of chemical lumbar sympathectomy （CLS） and corresponding preventive measures. Methods A retrospective study was conducted on 258 cases of CT-guided CLS（ injection of anhydrous alcohol） performed between September 2011 and September 2016 at Department of Pain Medicine, the First Hospital of Jiaxing City, and the complications and corresponding measures of prevention and treatment were analyzed. Results Surgical targets were successfully reached following the preplanned trajectories in all 258 cases （516 sides） undergoing CLS. In 16 cases （single side）, a small amount of blood was observed when the plunger was pulled back and the position of needle tip was adjusted（3. 1%, 16/516）. In 29 cases （single side）, some anhydrous alcohol leaked along the needle tract into the psoas major muscle and caused numbness in the area innervated by unilateral genital nerve in 7 cases and numbness and muscle weakness in unilateral lower limb in 1 case whose muscle strength recovered at 1 month post injection of diluted saline into the psoas major muscle. In 9 cases, anhydrous alcohol spread along the anterolateral margin of vertebral body upward to the level of L1 unilaterally（ 1.7% ,9/516）, among which 4 male（ 1.6% ,4/258） patients developed ejaculatory dysfunction post surgery. Postoperative CT scan revealed unilateral swelling of psoas major muscle in 2 cases, unilateral swelling of erector spinae muscle in 3 cases. No retroperitoneal hematoma occurred. Conclusions The most severe complication of CT-guided CLS seems to be neurological dysfunctions following injection of anhydrous alcohol affecting the lumbar plexus and LI sympathetic ganglia in male. Test with local anesthetics could be useful for preventing and early detection of those complications, ;rod implementation of saline dilution might serve as an effective treatment.