CT、超声引导下腹腔神经丛阻滞的应用价值探讨

Application Value of Celiac Plexus Block Guided by CT and Ultrasound

目的探讨CT、超声引导下进行腹腔神经丛阻滞的应用价值。方法选取2017年3月至2018年4月我院收治的上腹部顽固性癌痛患者41例,收集患者临床及影像学资料,根据引导方式的不同,将患者分为超声引导组(n=18)及CT引导组(n=23),比较两组患者止痛效果、成功率、阻滞剂分布及并发症情况。结果超声引导组患者治疗后24h、治疗后30d治愈率分别为66.66%、55.55%,超声引导组患者治疗后24h、治疗后30d有效率分别为100.00%、88.88%;CT引导组患者治疗后24h、治疗后30d治愈率分别为73.91%、56.52%,CT引导组患者治疗后24h、治疗后30d有效率分别为100.00%、86.95%。两组方式引导下腹腔神经丛阻滞止痛效果比较无明显差异(P>0.05);超声引导组腹腔神经丛阻滞止痛成功率为94.44%(17/18),术后均进行较大范围的CT扫描,17例患者中16例患者阻滞剂分布情况良好,双侧阻滞剂能汇合包绕腹主动脉,均匀分布于腹膜后间隙,1例患者因局部占位、分布情况不理想。CT引导组腹腔神经丛阻滞止痛成功率为100.00%(23/23),23例患者阻滞剂分布情况良好;两组患者均未出现严重并发症。结论CT、超声引导下腹腔神经丛阻滞临床止痛效果相当,但CT应用范围更广,可直观评估阻滞剂术中、术后分布情况。

Objective To evaluate the value of CT and ultrasound-guided celiac plexus block.Methods A total of 41 patients with intractable upper abdominal cancer pain were selected from March 2017 to April 2018.The clinical and imaging data of 41 patients with intractable upper abdominal cancer pain were collected.According to the different ways of celiac plexus block guided by patients,the patients were divided into two groups:ultrasound-guided group(n=18)and CT-guided group(n=23).The analgesic effect,success rate,distribution of blockers and complications were compared between the two groups.Results The cure rate of ultrasound-guided group was 66.66% and 55.55% after 24 hours and 30 days respectively.The effective rate of ultrasound-guided group was 100.00% and 88.88% after 24 hours and 30 days respectively.The cure rates of CTguided group were 73.91% and 56.52% after 24 hours and 30 days,respectively.The effective rates of CT-guided group were 100.00%and 86.95% after 24 hours and 30 days respectively.There was no significant difference in analgesic effect of celiac plexus block guided by two groups(P>0.05).In the ultrasound-guided group,the success rate of celiac plexus block was 94.44%(17/18).All patients underwent extensive CT scanning after operation.The distribution of blockers was good in 16 of the 17 patients.Bilateral blockers could converge around the abdominal aorta and evenly distribute in the retroperitoneal space.One patient had an unsatisfactory distribution due to local space occupancy.The success rate of celiac plexus block in CT-guided group was 100.00%(23/23),and the distribution of blockers was good in 23 patients.There were no serious complications in both groups.Conclusion The clinical analgesic effect of celiac plexus block guided by CT and ultrasound is comparable,but CT has a wider application scope,and can directly evaluate the distribution of blockers during and after operation.