阴部神经脉冲射频消融术联合阴部神经阻滞治疗阴部神经痛的临床疗效和安全性评价

Clinical efficacy and safety of a combined therapy of pulsed radiofrequency and pudendal nerve block in pudendal neuralgia patients

目的探讨阴部神经脉冲射频消融术(pulse radiofrequency,PRF)联合阴部神经阻滞(pudendal nerve blockade,PNB)治疗阴部神经痛的临床疗效和安全性评价。方法将80例阴部神经痛患者按电脑数字表法随机分为脉冲射频+阴部神经阻滞组(PRF+PNB组)和阴部神经阻滞组(PNB组),每组40例。PRF+PNB组患者行阴部神经PRF联合PNB治疗,PNB组行PNB治疗。于术后1、14、30、90 d对患者进行VAS评分随访,于术后第3个月行HPQ-9评分和疗效评估,并记录所有手术相关并发症。结果本次试验共77例患者完成了随访,PNB组39例,PRF+PNB组38例。术后1 d时,两组患者VAS评分较术前均降低(P<0.05),且组间差异无统计学意义(P>0.05)。术后14、30、90 d时PRF+PNB组VAS评分低于PNB组(P<0.05)。术后90 d时,PRF+PNB组患者健康问卷(Patient Health Quwstionnaire-9,HPQ-9)评分低于PNB组(P<0.05),PRF+PNB组术后90d有效率达92.1%,PNB组有效率为35.9%。两组均未随访观察到严重的不良反应。结论与单纯的PNB相比,阴部神经PRF联合PNB治疗,能够更长效地缓解阴部神经痛患者的疼痛症状,并对患者抑郁情绪有所改善,且不增加术后不良事件发生。

ObjectiveTo investigate the clinical efficacy and safety of the combined therapy of pulsed radiofrequency(PRF)and pudendal nerve block(PNB)in pudendal neuralgia patients.MethodsEighty patients diagnosed with pudendal neuralgia were randomly divided into a PRF+PNB group and a PNB group.The PRF+PNB group underwent both PRF and PNB,while the PNB group received PNB alone.All the patients were followed up to evaluate the Visual Analog Scale(VAS)scores and the Patient Health Quwstionnaire-9(HPQ-9)scores on the postoperative 1,14,30 d and 90 d after surgery.All the surgical complications were recorded.ResultsA total of 77 patients were followed up,including 39 patients in the PNB group and 38 patients in the PRF+PNB group.On the 1 d after surgery,both groups presented remarkably reduced VAS scores compared with pre-operative levels(P<0.05),without statistical difference between the two groups(P>0.05).However,compared with the PNB group,the PRF+PNB group showed marked decreases in the VAS scores on 14,30 d and 90 d after surgery(P<0.05).Furthermore,the PRF+PNB group showed marked lower HPQ-9 scores than the PNB group(P<0.05)in 90 d after operation.The 90 d effective rate was 92.1%for the PRF+PNB group and 35.9%for the PNB group.No severe adverse events were observed in either group.ConclusionsCompared with PNB treatment alone,the combined therapy of pudendal nerve PRF and PNB is effective to relieve pain in patients with pudendal neuralgia in a longer period of time and improve patients′depression symptoms,without postoperative adverse events.