腹横肌平面联合宫颈旁阻滞应用于子宫肌瘤经皮微波消融的初步研究

A preliminary study of transversus abdominis plane combined with paracervical block in percutaneous microwave ablation of uterine fibroids

目的探讨超声引导下腹横肌平面(TAP)联合宫颈旁阻滞在子宫肌瘤经皮微波消融(PMWA)中的安全性及有效性。方法回顾性分析2021年10月至2022年1月于四川省肿瘤医院行超声引导下TAP联合宫颈旁阻滞后PMWA的24例子宫肌瘤患者。记录TAP联合宫颈旁阻滞实施成功率、不良反应及患者术中、术后使用救援镇痛药物的种类和剂量。使用疼痛数字评分法(NRS)记录患者术中和术后30 min、1 h、2 h、4 h、6 h、12 h、24 h的疼痛程度并行量化评估,记录患者满意度。结果TAP联合宫颈旁阻滞实施成功率100%,且术中、术后均无不良反应发生。术中5例(20.83%)患者出现轻度疼痛,无需干预;4例(16.67%)患者出现中度疼痛,NRS评分分别为4分、4分、5分、6分,予以救援镇痛后症状缓解。所有患者均完成一次消融,无消融失败及二次消融者。术后部分患者有轻度疼痛,无需干预,且均于6 h内自然缓解。所有患者消融当天返回家中且对TAP联合宫颈旁阻滞镇痛效果满意度100%。结论超声引导下TAP联合宫颈旁阻滞应用于子宫肌瘤PMWA是安全、有效的,值得临床推广。

Objective To investigate the safety and efficacy of ultrasound-guided transversus abdominis plane(TAP)combined with paracervical block in percutaneous microwave ablation(PMWA)of uterine fibroids.Methods Twenty-four patients with uterine fibroids who underwent PMWA after ultrasound-guided TAP combined with paracervical block in Sichuan Cancer Hospital from October 2021 to January 2022 were retrospectively analyzed.The success rate and adverse reactions of TAP combined with paracervical block were recorded,and the types and doses of rescue analgesics used during and after operation were recorded.The pain degree of patients was recorded by NRS(numeric rating scales)during and 30 minutes,1 hour,2 hours,4 hours,6 hours,12 hours and 24 hours after operation,and the satisfaction of patients was recorded.Results The success rate of TAP combined with paracervical block was 100%,and there were no adverse reactions during and after operation.During the operation,5 patients(20.83%)had mild pain,which was tolerable and did not need intervention,4 patients(16.67%)presented with moderate pain,and the NRS scores were 4,4,5 and 6 respectively,the symptoms were relieved after rescue analgesia.All patients completed one ablation,no ablation failure or secondary ablation.Some patients had mild pain after operation,which could be tolerated without intervention,and all were relieved naturally within 6 hours.All patients returned home on the day of ablation and were 100%satisfied with the analgesic effect.Conclusions Ultrasound-guided TAP combined with paracervical block in PMWA of uterine fibroids is safe and effective,which is worthy of clinical promotion.