CT引导腹腔神经丛阻滞术在上腹部顽固性癌痛治疗中的应用

Application of CT-guided Neurolytic Celiac Plexus Block in the Treatment of Intractable Upper Abdomen Cancer Pain

目的探讨CT引导腹腔神经丛阻滞术(NCPB)在上腹部顽固性癌痛治疗中的应用。方法选择我院2016年3月-2018年3月收治的55例腹部晚期恶性肿瘤患者为研究对象。患者伴腹膜后淋巴结转移,存在顽固性上腹部疼痛,经药物止痛效果不佳,于我院行CT引导下NCPB。采用视觉模拟评分法(VAS)评估疼痛程度和止痛效果,Karnofsky功能状态评分(KPS)评估生活质量,记录不良反应情况。结果55例患者在术后3个月内无1例死亡,在术后24h、2周、1个月、2个月、3个月的止痛总有效率分别为100%、96.36%、94.55%、90.91%、83.64%;与术前比较,患者术后7d、2周、1个月、2个月、3个月的KPS评分均明显升高(P<0.05);围术期有轻度并发症,对症处理后均恢复正常。结论对腹部晚期恶性肿瘤伴有顽固性癌痛者采取CT引导下NCPB,可取得较好的止痛效果,且能改善生活质量,术中CT引导则能保证手术具有较高安全性。

Objective To explore the application of CT-guided neurolytic celiac plexus block(NCPB)in the treatment of intractable upper abdomen cancer pain.Methods A total of 55 patients with advanced malignant abdomen tumors from March 2016 to March 2018 in our hospital were selected for the study.The patients were with retroperitoneal lymph node metastasis,and they had intractable upper abdominal pain,and they had poor analgesic effects after drugs,and they were given NCPB under the CT guidance in our hospital.Pain degree and analgesic effects were assessed by visual analogue scale(VAS),and Karnofsky functional status score(KPS)was used to assess quality of life,and the adverse reactions were recorded.Results There were no deaths in 55 patients within 3 months after operation,and the total effective rates of pain relief at 24h,2 w,1 month,2 months and 3 months after operation were 100%,96.36%,94.55%,90.91% and 83.64% respectively.Compared with before operation,the KPS scores at 7d,2 w,1 month,2 months and 3 months after operation were significantly increased(P<0.05).There were mild complications during perioperative period,and the patients returned to normal after symptomatic treatment.Conclusion CT-guided NCPB in patients with advanced abdominal malignant tumors and intractable cancer pain can achieve good analgesic effects and improve quality of life,and intraoperative CT guidance can ensure high safety of surgery.