放射线引导下经椎间盘入路内脏大小神经毁损术治疗上腹部癌痛的临床分析

Clinical analysis of Great and Lesser Splanchnic Nerve Neurolysis for Epigastric Cancer Pain Via Intervertebral Disc under X-ray Guidance

目的:观察放射线引导下经椎间盘入路毁损内脏神经治疗上腹部癌痛的疗效及安全性。方法:选择上腹部癌痛患者26例,在放射线引导下经T11~12椎间盘入路穿刺,注射无水乙醇5.0 mL毁损内脏大、小神经,观察穿刺成功率,并记录术前、术后1天、1周、2周、1月、2月的疼痛强度(NRS评分)、生活质量评分(QOL),阿片类药物的用量以及手术不良反应的发生情况。结果:所有患者均穿刺到位,无严重并发症出现。和术前相比,术后各时点的NRS评分、每日吗啡消耗量下降,QOL评分增加(P<0.05)。其中,6例患者发生暂时性腹泻,一周内恢复;5例患者出现不同程度的腹背部烧灼感,未经特殊处理24 h后症状消失。结论:在放射线引导下经椎间盘入路毁损内脏神经治疗上腹部癌痛的操作简单,疗效好,可显著提高患者的生活质量,且安全性高。

Objective： To investigate the therapeutic effect and safety of great and lesser splanchnic nerve neurolysis via intervertebral disc under X-ray guidance in patients with epigastric cancer pain. Methods： Twenty six patients with epigastric cancer pain were enrolled,and the great and lesser splanchnic nerve were performed neurolysis with 5 ml absolute ethanol via T11-12 intervertebral disc approach under X-ray guidance. The severity of pain,numerical rating scale（NRS） and quality of life（QOL）,dose of opioid drug and occurrence of adverse events were recorded at 1 day,1 week,2 weeks,1 month,2 months after surgery. Results： All patients were successfully operated,and no serious complications occurred. Compared with that preoperation,NRS score and daily morphine consumption were decreased,QOL score increased at each time point postoperation（P〈0.05）. Six patients had transient diarrhea and recovered within a week,5 patients appeared different degree of the abdomen and back burning pain,and the symptoms disappeared after24 h with nontreatment. Conclusion： The neurolysis of great and lesser splanchnic nerve via intervertebral disc with X-ray guidance was easy to operate,effective for epigastric cancer pain,it could improve the quality of life with high safety.