CT引导下阴部神经脉冲射频术联合奇神经节毁损术治疗会阴部疼痛的疗效分析

Analysis on curative effect of CT-guided perineal nerve pulse radiofrequency combined with ganglion impar destruction in the treatment of perineal pain

目的探讨CT引导下阴部神经脉冲射频术联合奇神经节毁损术治疗会阴部疼痛的有效性和安全性。方法共18例会阴部疼痛患者于CT引导下行阴部神经脉冲射频术联合奇神经节毁损术,分别于术前和术后1 d、15 d、1个月、3个月、6个月采用视觉模拟评分(VAS)评价疼痛程度、疼痛障碍指数(PDI)评价功能障碍程度、匹兹堡睡眠质量指数(PSQI)评价睡眠质量,计算总有效率,记录术后并发症[包括下肢运动和(或)感觉障碍、会阴部感觉异常、排尿和(或)排便障碍、穿刺部位感染和(或)出血等]。结果治疗前后VAS(F=201.421,P=0.023)、PDI(F=178.214,P=0.020)和PSQI(F=168.241,P=0.045)评分差异有统计学意义,其中,治疗后1 d、15 d、1个月、3个月和6个月VAS(t=19.562,P=0.002;t=17.451,P=0.015;t=12.583,P=0.026;t=15.246,P=0.002;t=19.458,P=0.000)、PDI(t=14.265,P=0.004;t=12.356,P=0.000;t=11.235,P=0.032;t=9.254,P=0.024;t=13.265,P=0.003)和PSQI(t=15.213,P=0.021;t=10.235,P=0.003;t=7.450,P=0.000;t=6.352,P=0.002;t=14.521,P=0.012)评分均低于治疗前。总有效率为16/18,无一例发生下肢运动和(或)感觉障碍、会阴部感觉异常、排尿和(或)排便障碍、穿刺部位感染和(或)出血等不良反应。结论 CT引导下阴部神经脉冲射频术联合奇神经节毁损术治疗会阴部疼痛安全、有效。

Objective To investigate the efficacy and safety of perineal nerve pulse radiofrequency combined with ganglion impar destruction in the treatment of perineal pain. Methods A total of 18 cases of perineal pain were treated by CT-guided perineal nerve pulse radiofrequency combined with ganglion impar destruction. Before and 1 d, 15 d, 1 month, 3 months and 6 months after treatment, Visual Analogue Scale（VAS） was used to evaluate the degree of pain, Pain Disability Index（PDI） was used to evaluate severity of dysfunction, and Pittsburgh Sleep Quality Index（PSQI） was used to evaluate sleep quality. The total effective rate of treatment was calculated, and postoperative complications were recorded, including movement and/or sensory disturbances of lower limbs, perineal paresthesia, urination and/or defecation disorders, puncture site infection and/or bleeding. Results There were significant differences before and after treatment on VAS scores（F = 201.421, P = 0.023）, PDI scores（F = 178.214, P = 0.020） and PSQI scores（F = 168.241, P=0.045）. Compared with before treatment, VAS scores（t = 19.562, P = 0.002; t =17.451, P = 0.015; t= 12.583, P = 0.026; t= 15.246, P = 0.002;t= 19.458, P = 0.000）, PDI scores（t= 14.265,P=0.004;t= 12.356, P = 0.000; t= 11.235, P = 0.032; t=9.254, P = 0.024; t=13.265, P = 0.003） and PSQI scores（t= 15.213, P = 0.021; t = 10.235, P = 0.003;t =7.450, P = 0.000;t =6.352, P = 0.002;t= 14.521, P =0.012） at 1 d, 15 d, 1 month, 3 months and 6 months after treatment were lower than those before treatment.The total effective rate of treatment was 16/18. No adverse reactions including lower limb movement and/or sensory disturbances, perineal paresthesia, urination and/or defecation disorders, puncture site infection and/or bleeding occurred. Conclusions CT-guided perineal nerve pulse radiofrequency combined with ganglion impar destruction is safe and effective in the treatment of perineal pain.